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CVS > 17 - Heart Failure Investigations > Flashcards

17 - Heart Failure Investigations Flashcards

1
Q

What are the different classifications of heart failure using the NYHA system?

A
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2
Q

Outline the aetiology of heart failure

A
  • Ischaemic Heart Disease
  • Hypertension
  • Dilated/hypertrophic Cardiomyopathy
  • Valvular/Congenital Heart Disease
  • Pericardial disease
  • Arrhythmias
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3
Q

Explain why beta blockers are beneficial following myocardial infarction?

A
  • MI causes increased sympathetic activity
  • β-blockers reduce O2 demand, hence reducing myocardial ischaemia
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4
Q

Identify 4 features of heart failure

A
  • Reduced force of contraction or reduced filling
  • Reduced cardiac output
  • Reduced tissue perfusion
  • Oedema
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5
Q

What drugs in general are used for heart failure?

A

Anticoagulants

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6
Q

What is furosemide?

A
  • Diuretic that can lessen symptoms such as shortness of breath and swelling in your arms, legs, and abdomen by reducing excess fluid in the blood
  • Immediate venodilator, 30 min diuretic
  • Higher doses needed in renal failure as poorer kidney perfusion
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7
Q

Why would you give IV nitrates to someone with heart failure?

A

Forms nitrous oxide causing vasodilation decreasing pre and after loads

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8
Q

What might you see on the chest x-ray of someone with heart failure?

A
  • Cardiomegaly
  • Fluid in the fissure
  • Pleural effusions
  • Pulmonary oedema
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9
Q

What investigations would you carry out to diagnose heart failure and the cause of it?

A
  • CXR
  • Transthoracic echocardiogram
  • ECG
  • Blood tests (FBC and BNP/NTpro-BNP)
  • Possible coronary angiography for MRI for ischaemia
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10
Q

What blood tests can be carried out to investigate heart failure?

A
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11
Q

How can BNP be used to diagnose heart failure?

A
  • Hormone released in reponse to atria/ventricle stretch due to fluid overloads
  • Normal range varies with age and gender
  • Atrial fibrillation can triple BNP
  • Normal BNP can pretty much rule out heart failure
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12
Q

Why are beta blockers used for heart failure and why do they need to be used with caution?

A
  • Negative inotrope so decrease workload of the heart
  • Body could be depending on the tachycardia to supply the metabolic demands of the body so titrate slowly
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13
Q

What are the bad effects of the sympathetic nervous system being activated in heart failure?

A
  • beta receptors are down-regulated/uncoupled so when needed not available
  • Noradrenaline can induce cardiac hypertrophy/myocyte apoptosis and can upregulate RAAS
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14
Q

What changes does the SNS make to the CVS when activated in heart failure?

A
  • Increase contractility
  • Vasoconstriction
  • Tachycardia

ALL TO INCREASE THE CO

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15
Q

What drugs can you use to combat the RAAS system?

A

- ACE inhibitors: prevent productuon of angiotensin II which is a vasoconstrictor and produces aldosterone so inhibitor stops this too.

- Angiotensin II receptor blocker

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16
Q

Although an angiotensin II receptor blocker may be being used, some aldosterone may still be produced increasing B.P. What drug can be used to combat this?

A
  • Spironolactone
  • Aldosterone receptor antagonist
17
Q

Apart from drug treatment, what can be used to treat end stages of heart failure?

18
Q

Outline the different stages of treating HFrEF.

A

To treat HFpEF best to treat the underlying cause

19
Q

For the different types of heart failure outline the best treatment options:

  • Left ventricular systolic dysfunction
  • HFpEF
  • Valvular heart failure
  • Right ventricular failure
20
Q

What are some of the causes of pericarditis?

A
  • Viral infection (Influenza, Cockisackie)
  • TB
  • Chest trauma
  • Post surgical
21
Q

Someone has a suspected heart failure or MI, what investigations can be done bar a blood test, ECG, echocardiogram and chest x-ray?

A

Coronary angiography with possible angiplasty

22
Q

What are a few reasons someone may have a systolic murmur following a viral infection like rheumatic fever?

A
  • Aortic valve stenosis
  • Severe anaemia of chronic disease causing an increase in CO
23
Q

If someone has gone into heart failure from an MI what clinical investigations should be carried out?

A
  • Chest XR
  • U and E’s
  • FBC
  • Trop test
24
Q

Do you think Arthur’s lungs are easy to inflate?

25
Q

Following the previous case study of Arthur, why is his sputum creamy?

27
Q

Why might someone feel nauseous in acute heart failure?

A

Heptomegaly pushing on stomach of patient and causin irritation to gastric mucosa

28
Q

Also, which side of the heart has failed?

A
  • Right sided heart failure secondary to lung disease (cor pulmonale)
  • Can occur as a consequence of lung disease which elevates pulmonary resistance and therefore pressure in the pulmonary artery
29
Q

How can you treat someone with cor pulmonale to help their heart failure?

A

Treat the underlying lung condition

CVS (19 decks)

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