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Cardiology > 1: Heart Failure > Flashcards

1: Heart Failure Flashcards

1
Q

Define Heart Failure

A

When cardiac output is insufficient to meet the bodies requirements

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2
Q

What are the two types of heart failure

A

Systolic and diastolic

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3
Q

What is systolic heart failure

A

Impaired ability of the heart to contract - resulting in impaired cardiac output

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4
Q

How can systolic HF be identified

A

An Ejection Fraction <40%

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5
Q

What is diastolic heart failure

A

Impaired ability of the heart to relax resulting in increasing filling pressure and reduced filling

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6
Q

What is diastolic heart failure also referred to as

A

Heart Failure with Preserved Ejection Fraction

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7
Q

What is the ejection fraction in diastolic heart failure

A

>50%

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8
Q

What are the 3 types of heart failure relating to site

A

Left-sided HF

Right-sided HF

Congestive (biventricular HF)

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9
Q

What is high-output heart failure

A

When there is no intrinsic problem with the heart, but there is increased demand. Heart failure occurs when the increased demand cannot be met

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10
Q

How common is high output heart failure

A

Rare

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11
Q

What is low output heart failure

A

Where cardiac output is low and does not increase with demand

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12
Q

What is acute heart failure

A

new onset or decompensation of chronic heart failure. Which present with symptoms of peripheral oedema or pulmonary oedema, with or without signs of peripheral hypoperfusion.

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13
Q

What is chronic heart failure

A

clinically compensated heart failure

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14
Q

How does the incidence of HF change with age

A

Incidence of HF increases

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15
Q

What are 2 common causes of systolic HF

A

IHD

Cardiomyopathy

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16
Q

What are 5 causes of diastolic heart failure

A

Left ventricular hypertrophy

Restrictive cardiomyopathy

Cardiac tamponade

Constrictive pericarditis

Obesity

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17
Q

What are 3 causes of left ventricular failure

A

Aortic stenosis

Mitral regurgitation

HTN

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18
Q

What are 3 causes of right ventricular failure

A

Cor Pulmonale

Left-sided HF

Pulmonary stenosis

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19
Q

What is the commonest cause of right ventricular failure

A

Cor pulmonale secondary to COPD

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20
Q

What are the 3 aetiological categories of low-output HF

A
  1. Excess pre-load
  2. Pump Failure
  3. Excess afterload
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21
Q

What are the 2 causes of low-out put HF due to excess pre-load

A

Fluid Overload

Mitral regurgitation

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22
Q

What are the 2 causes of pump failure leading to low-output HF

A
  • Reduced SA node activity (eg. B blockers)
  • Negative inotropic drugs
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23
Q

What are the 2 causes of low-output HF due to chronic afterload

A
  • aortic stenosis
  • HTN
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24
Q

What are 6 causes of high output HF

A
  • pregnancy
  • hyperthyroidism
  • beri beri
  • anaemia
  • paget’s disease
  • AV malformation
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25
Q

What are 10 symptoms of left-sided HF

A
  • Dyspneoa
  • Orthopneoa
  • Paroxysmal Nocturnal Dyspneoa
  • Nocturnal cough - productive of pink frothy sputum
  • Wheeze
  • Lethargy
  • Cold extremities
  • Weight loss
26
Q

What are 6 symptoms of right-sided HF

A
  • Peripheral oedema
  • Ascites
  • Facial engorment
  • Epistaxis
  • Anorexia
  • Nausea
27
Q

How will congestive heart failure present clincially

A

Symptoms of both left and right HF

28
Q

What criteria is used to diagnose HF

A

Framingham criteria

29
Q

What diagnostic criteria can be used to diagnose heart failure

A

Framingham

30
Q

What does the Franingham criteria state is requried to diagnose HF

A

To diagnose congestive HF indiviudal must have at least 1 major and 2 minor symptoms. Or, 2 major symptoms

31
Q

What are the 8 major franingham criteria

A
  • >4.5Kg weight loss in 5 days following treatment
  • S3 Gallop rhythm
  • Pulmonary rales
  • PND
  • Neck vein distention
  • Hepatojugular reflex
  • Cardiomegaly
  • Acute pulmonary oedema
32
Q

What are the 6 minor franingham criteria

A
  • Ankle oedema
  • Dyspneoa on exertion
  • Hepatomegaly
  • Nocturnal cough
  • Pleural effusion
  • Tachycardia >120
33
Q

What scale is used to assess the severity of heart failure

A

New York Heart Association

34
Q

What is NYHA I criteria

A

Ordinary physical activity not limited by symptoms

35
Q

What is NHYA II criteria

A

Slight limitation of physical activity.

Symptoms occur on physical activity.

36
Q

What is NYHA criteria III

A

Marked limitation of physical activity. Symptoms occur at less than ordinary levels of physical activity

37
Q

What is NYHA criteria IV

A

Symptoms at rest

38
Q

What is first-line investigation for HF

A

N-terminal pro BNP- (NT pro BNP)

39
Q

If an individual has a pro NT BNP of >2000 what should be done

A

Refer for urgent transthoracic ECHO within 2W

40
Q

If an individal has a pro-NT BNP of 400-2000 what should be done

A

Refer for transthoracic ECHO in 6W

41
Q

If an individual has a NT pro BNP of <400 what should be done

A

Consider an alternative diagnosis

42
Q

What is second line investigation for HF

A

Transthoracic ECHO

43
Q

how soon should a transthoracic ECHO be performed if

a. BNP >2000
b. BNP: 400-2000

A

a. 2W
b. 6W

44
Q

What may be seen on an ECG on heart failure

A

Non-specific findings (perhaps indicating underlyign cause)

  • Ischaemic changes (evidence of past MIs)
  • Sokolov-Lyon Criteria = indicate LVH (and left axis deviation)
  • Arrythmias
45
Q

What are the features of HF on CXR

A

Alveolar oedema (Bat wing sign)

Kerley B lines

Cardiomegaly

Dilated upper lobe veins

pleural Effusions

46
Q

What is first-line for the managemement of CHRONIC heart failure

A

ACEi and B blocker

47
Q

What are the 3 B blocks that can be used in HF

A

Carvediol

Bisoprolol

Nabivolol

48
Q

What should be checked before starting a ACEi

A

U+E

Renal function

49
Q

How should B blocker and ACEi be started in HF

A

Should be started individually - it doesn’t matter which drug is started first

50
Q

What is second line to manage HF

A

Spirinolactone

51
Q

When should spirinolactone be addedd to management of HF

A

If individuals are still symptomatic despite B blocker and ACEi

52
Q

What else may be given to manage HF

A
53
Q

What are the indications for ivabrandine in the management of HF

A

HR >75

Class III or IV HF

Given with other medications (ACEi, B blocker, Spirinolactone)

54
Q

When may digoxin be given in HF

A

Severe HF with reduced ejection fraction despite optimal therapy

55
Q

What two vaccines should individuals with heart failure have

A

pneumococcal vaccine

annual influenza vaccine

56
Q

What are 3 pieces of lifestyle advice for someone with HF

A

Smoking cessation

Reduce Salt Consumption

Reduce Alcohol Intake

57
Q

What 4 drugs improve survival in HF

A

Bblocker

ACEi

Spirolonactone

Hydralazine w/nitrates

58
Q

What are 2 scoring systems that can be used to predict survival in HF

A
  • CHARM
  • Corona
59
Q

What is prognosis of the following NYHA grades of HF

a. I
b. II
c. III
d. IV

A

a. 95%
b. 85%
c. 85%
d. 35%

60
Q

What are 3 complications of heat failure

A

Pulmonary oedema

Renal failure

Portal HTN

Atrial fibrillation

Cardiology (13 decks)

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