Signs, Symptoms & RFs

• What are the risk factors of HF?

  Ischaemic heart disease

  Congenital heart disease

  Cardiomyopathies

  HTN

  Pulmonary HTN

  Valvular disease

  Arrhythmias

  Age (over 65)

  Smoking

  Obesity
• What is the most common cause of HF?

  Ischaemic heart disease

  60% of HF pts
• How can ischaemic heart disease lead to HF?

  Ischaemia -> damage & necrosis of cardiac tissue -> regional movement abnormalities of myocytes -> reduced contractility -> reduced CO -> trigger 'vicious cycle' of HF
• How can hypertrophic cardiomyopathy lead to HF?

  Muscle of ventricles become thickened -> reduces volume ventricle can hold & reduces amount of blood it can pump out during systole

  Often don't get a change in ejection fraction (as smaller volume & output, so EF stays the same)

  Decreased CO -> starts HF vicious cycle
• How can restrictive cardiomyopathy lead to HF?

  Muscle walls become more fibrous -> don't move in the same way -> altered filling & ejection

  EF can be variable
• How can dilated cardiomyopathy lead to HF?

  Muscle walls are thin & stretched -> hold larger volume but without muscle capacity to force blood out in systole -> reduced EF
• Fill in the blanks

  A) Hypertrophic

  B) Restrictive

  C) Dilated

  
• How does HTN lead to development of HF?

  Can be due to...

  • complications of ischaemic heart disease
  • progression of diastolic dysfunction to HF with preserved EF

  Diastolic dysfunction

  • abnormalities in diastolic filling, distensibility & relaxation of left ventricle -> left ventricular hypertrophy -> increased cardiac work -> left ventricular failure
• How does pulmonary HTN lead to HF?

  Pulmonary HTN → pulmonary venous congestion → increased ANP & BNP → increased cardiac work → enters HF vicious cycle
• How does valvular disease lead to HF?

  Valves can either be stenotic or regurgative

  Stenosis

  • Valves are stiff & struggle to open → restricted blood flow → decreased CO → stimulates RAAS → increased afterload & preload → increased cardiac work → HF

  Regurgitation

  • Valves are leaky & don’t close properly → backflow → decreased CO → … → HF
• How do arrhythmias lead to HF?

  Atrial Fibrillation - most common arrhythmia

  AF → disrupts normal cycle → reduced CO → starts vicious cycle of HF
• How does age increase the risk of HF?

  Age is a big risk associated with cardiovascular disease → increased risk of MI → leads back to ischaemic heart disease
• How does smoking increase the risk of HF?

  Smoking increases risk of atherosclerosis → increased risk of MI → leads back to ischaemic heart disease point
• How does obesity lead to increased risk of HF?

  Obesity → higher cardiac demand → left ventricular dilatation & therefore hypertrophy (due to increased wall stress) → ventricular wall becomes stiff → reduced pumping ability → decrease CO → enters HF vicious cycle

  Obesity also increases lipid levels -> hypercholesterolaemia -> increased risk of atherosclerosis
• What are the signs & symptoms of right sided HF?

  Oedema in feet, ankles & legs

  Hepatomegaly

  Ascites

  Raised JVP

  Exercise intolerance
• How do pts with RHF develop oedema?

  HF → lack of renal perfusion → stimulates RAAS → fluid & water retention → oedema
• How do pts with RHF develop hepatomegaly?

  Increased blood volume & decreased CO → venous congestion within the liver → hepatomegaly
• How do pts with RHF develop ascites?

  HF → lack of renal perfusion → stimulates RAAS → fluid & water retention → oedema & ascites
• How do pts with RHF develop raised JVP?

  No valves between internal jugular vein & RA → therefore, raised JVP means increased right atrial pressure
• How do pts with HF develop exercise intolerance?

  On exertion, O2 demand increases → CO attempts to increase, but in HF cannot increase enough → exercise intolerance
• What are the signs & symptoms of left sided HF?

  Dyspnoea

  Orthopnoea

  Paroxysmal nocturnal dyspnoea

  Pulmonary congestion & oedema

  Exercise intolerance
• How do pts with LHF develop dyspnoea?

  L sided HF → blood begins to pool in lungs → pulmonary congestion

  Excess fluid in lungs makes it difficult to breathe

  Also heart has reduced CO, so increases HR to try to increase it → increased resp rate to get more O2 into body
• How do pts with LHF develop orthopnoea?

  Breathlessness when lying flat -> pulmonary oedema settles across lungs (due to gravity)
• How do pts with LHF develop paroxysmal nocturnal dyspnoea?

  Lying flat at night → pulmonary oedema settles across large SA on lungs (due to gravity)

  Pts will begin to prop themselves up with multiple pillows to be able to sleep
• What is paroxysmal nocturnal dyspnoea?

  Suddenly waking up in the middle of the night with severe SOB → may cause them to cough & wheeze
• How do pts with LHF develop pulmonary congestion & oedema?

  L sided HF → blood begins to pool in lungs → pulmonary congestion & oedema
• What causes a gallop rhythm?

  Caused by a 3rd and/or 4th heart sound

  3rd heart sound

  • due to ventricular filling (heard in significant heart failure)

  4th heart sound

  • in late diastole (associated with atrial contraction)
  • can be caused by significant left ventricular hypertrophy
• What causes basal crepitations?

  Crackling sounds heard in the lungs during inhalation

  Indicated fluid accumulation in lungs (pulmonary oedema)