1: Heart Failure Flashcards
Define Heart Failure
When cardiac output is insufficient to meet the bodies requirements
What are the two types of heart failure
Systolic and diastolic
What is systolic heart failure
Impaired ability of the heart to contract - resulting in impaired cardiac output
How can systolic HF be identified
An Ejection Fraction <40%
What is diastolic heart failure
Impaired ability of the heart to relax resulting in increasing filling pressure and reduced filling
What is diastolic heart failure also referred to as
Heart Failure with Preserved Ejection Fraction
What is the ejection fraction in diastolic heart failure
>50%
What are the 3 types of heart failure relating to site
Left-sided HF
Right-sided HF
Congestive (biventricular HF)
What is high-output heart failure
When there is no intrinsic problem with the heart, but there is increased demand. Heart failure occurs when the increased demand cannot be met
How common is high output heart failure
Rare
What is low output heart failure
Where cardiac output is low and does not increase with demand
What is acute heart failure
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.
What is chronic heart failure
clinically compensated heart failure
How does the incidence of HF change with age
Incidence of HF increases
What are 2 common causes of systolic HF
IHD
Cardiomyopathy
What are 5 causes of diastolic heart failure
Left ventricular hypertrophy
Restrictive cardiomyopathy
Cardiac tamponade
Constrictive pericarditis
Obesity
What are 3 causes of left ventricular failure
Aortic stenosis
Mitral regurgitation
HTN
What are 3 causes of right ventricular failure
Cor Pulmonale
Left-sided HF
Pulmonary stenosis
What is the commonest cause of right ventricular failure
Cor pulmonale secondary to COPD
What are the 3 aetiological categories of low-output HF
- Excess pre-load
- Pump Failure
- Excess afterload
What are the 2 causes of low-out put HF due to excess pre-load
Fluid Overload
Mitral regurgitation
What are the 2 causes of pump failure leading to low-output HF
- Reduced SA node activity (eg. B blockers)
- Negative inotropic drugs
What are the 2 causes of low-output HF due to chronic afterload
- aortic stenosis
- HTN
What are 6 causes of high output HF
- pregnancy
- hyperthyroidism
- beri beri
- anaemia
- paget’s disease
- AV malformation
What are 10 symptoms of left-sided HF
- Dyspneoa
- Orthopneoa
- Paroxysmal Nocturnal Dyspneoa
- Nocturnal cough - productive of pink frothy sputum
- Wheeze
- Lethargy
- Cold extremities
- Weight loss
What are 6 symptoms of right-sided HF
- Peripheral oedema
- Ascites
- Facial engorment
- Epistaxis
- Anorexia
- Nausea
How will congestive heart failure present clincially
Symptoms of both left and right HF
What criteria is used to diagnose HF
Framingham criteria
What diagnostic criteria can be used to diagnose heart failure
Framingham
What does the Franingham criteria state is requried to diagnose HF
To diagnose congestive HF indiviudal must have at least 1 major and 2 minor symptoms. Or, 2 major symptoms
What are the 8 major franingham criteria
- >4.5Kg weight loss in 5 days following treatment
- S3 Gallop rhythm
- Pulmonary rales
- PND
- Neck vein distention
- Hepatojugular reflex
- Cardiomegaly
- Acute pulmonary oedema
What are the 6 minor franingham criteria
- Ankle oedema
- Dyspneoa on exertion
- Hepatomegaly
- Nocturnal cough
- Pleural effusion
- Tachycardia >120
What scale is used to assess the severity of heart failure
New York Heart Association
What is NYHA I criteria
Ordinary physical activity not limited by symptoms
What is NHYA II criteria
Slight limitation of physical activity.
Symptoms occur on physical activity.
What is NYHA criteria III
Marked limitation of physical activity. Symptoms occur at less than ordinary levels of physical activity
What is NYHA criteria IV
Symptoms at rest
What is first-line investigation for HF
N-terminal pro BNP- (NT pro BNP)
If an individual has a pro NT BNP of >2000 what should be done
Refer for urgent transthoracic ECHO within 2W
If an individal has a pro-NT BNP of 400-2000 what should be done
Refer for transthoracic ECHO in 6W
If an individual has a NT pro BNP of <400 what should be done
Consider an alternative diagnosis
What is second line investigation for HF
Transthoracic ECHO
how soon should a transthoracic ECHO be performed if
a. BNP >2000
b. BNP: 400-2000
a. 2W
b. 6W
What may be seen on an ECG on heart failure
Non-specific findings (perhaps indicating underlyign cause)
- Ischaemic changes (evidence of past MIs)
- Sokolov-Lyon Criteria = indicate LVH (and left axis deviation)
- Arrythmias
What are the features of HF on CXR
Alveolar oedema (Bat wing sign)
Kerley B lines
Cardiomegaly
Dilated upper lobe veins
pleural Effusions
What is first-line for the managemement of CHRONIC heart failure
ACEi and B blocker
What are the 3 B blocks that can be used in HF
Carvediol
Bisoprolol
Nabivolol
What should be checked before starting a ACEi
U+E
Renal function
How should B blocker and ACEi be started in HF
Should be started individually - it doesn’t matter which drug is started first
What is second line to manage HF
Spirinolactone
When should spirinolactone be addedd to management of HF
If individuals are still symptomatic despite B blocker and ACEi
What else may be given to manage HF
What are the indications for ivabrandine in the management of HF
HR >75
Class III or IV HF
Given with other medications (ACEi, B blocker, Spirinolactone)
When may digoxin be given in HF
Severe HF with reduced ejection fraction despite optimal therapy
What two vaccines should individuals with heart failure have
pneumococcal vaccine
annual influenza vaccine
What are 3 pieces of lifestyle advice for someone with HF
Smoking cessation
Reduce Salt Consumption
Reduce Alcohol Intake
What 4 drugs improve survival in HF
Bblocker
ACEi
Spirolonactone
Hydralazine w/nitrates
What are 2 scoring systems that can be used to predict survival in HF
- CHARM
- Corona
What is prognosis of the following NYHA grades of HF
a. I
b. II
c. III
d. IV
a. 95%
b. 85%
c. 85%
d. 35%
What are 3 complications of heat failure
Pulmonary oedema
Renal failure
Portal HTN
Atrial fibrillation
