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Cardiac Failure (Clinical Presentation (Dyspnoea especially when lying…
Cardiac Failure
Clinical Presentation
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Three cardinal symptoms are; SOB, fatigue and ankle swelling (non-specific symptoms)
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Treatment
Lifestyle changes
Avoid large meals, lose weight, stop smoking, exercise, vaccination
Diuretics
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Types; loop diuretic (furosemide), thiazide diuretic (bendroflumethiazide - inhibit sodium reabsorption in DCT) & aldosterone antagonist (epelerone - inhibits ADH release resulting in water loss - beware of renal impairment + hyperkalaemia)
Promote sodium and thus water loss thereby reducing ventricular filling pressure (preload) decreasing systemic and pulmonary congestion
ACE inhibitors
Examples - ramipril, enalipril, captopril
Side effects - cough (bradykinin related), hypotension, hyperkalaemia and renal dysfunction
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Beta blockers
Bisoprolol, nebivolol, carvedilol are examples
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Surgery to repair - mitral valve repair, aortic or mitral valve replacement
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Risk factors
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Men (due to lack of protective effect provided by oestrogen resulting in the early onset of IHD in men)
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Epidemiology
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Main causes
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Cardiomyopathy (disease of heart muscles, where the walls have become thickened, stiff or stretched)
Valvular heart disease e.g. aortic stenosis, aortic and mitral regurgitation
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Any factor that increases myocardial work e.g. anaemia, arrhythmias, hyperthyroidism, pregnancy and obesity
Diagnosis
Blood Tests
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FBC, U&E's and liver biochemistry
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ECG
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Shows underlying causes; ischaemia, left ventricular hypertrophy in hypertension or arrhythmia
Echocardiography
Look for regional wall motion abnormalities, valvular disease and cardiomyopathies
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Definition
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Can result from any structural or functional cardiac disorder that impairs the hearts inability to function and meet the demands of supplying sufficient oxygen and nutrients to the metabolising body
The inability of the heart to deliver blood and thus O2 at a rate that is commensurate with the requirement of metabolising tissue of the body
Pathophysiology
When the heart begins to fail, there are many systems involved that initiate physiological COMPENSATORY CHANGES that try to maintain cardiac output and peripheral perfusion in order to negate the effects of the heart failure
However as heart failure progresses, these mechanisms are overwhelmed and become pathophysiological also known as DECOMPENSATION
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