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Cardiovascular Week 5 2016/17 > 3: Heart failure > Flashcards

3: Heart failure Flashcards

1
Q

What is another name for heart failure?

A

Congestive cardiac failure (CCF)

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2
Q

CCF is a (disease / collection of diseases).

A

collection of diseases

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3
Q

What is the main cause of CCF?

A

Low cardiac output

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4
Q

What are the three types of congestive cardiac failure (CCF)?

A

a) Left heart failure
b) Right heart failure
c) Mixed

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5
Q

An example of acute left heart failure is…

A

left ventricular failure.

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6
Q

CCF can be either acute or ___.

A

chronic

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7
Q

Signs and symptoms associated with CCF usually come about due to ___ ___.

A

fluid retention

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8
Q

Name three cardiac conditions which cause left heart failure.

A

Ischaemic heart disease » myocardial infarction

Cardiomyopathy

Valvular disease

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9
Q

Right sided heart failure is ___ to left heart failure.

A

secondary

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10
Q

Name two cardiac conditions which cause right sided heart failure.

A

Cor pulmonale

Congenital heart disease

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11
Q

What are some symptoms of left sided heart failure?

A
  • Dyspnoea on exertion/rest
  • Orthopnoea
  • PND (paroxysmal nocturnal dyspnoea)
  • Pulmonary oedema
    • sudden dsypnoea, PINK FROTHY SPUTUM
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12
Q

What are some clinical signs of left sided heart failure?

A

Tachycardia

Fine crepitations

Pleural effusion

Third heart sound

On a CXR you may see cardiomegaly, bats wing shadows in the lower zones and interstitial fluid.

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13
Q

What is a clinical symptom of right sided heart failure?

A

Oedema (ankle / sacral)

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14
Q

What are some clinical signs of right sided heart failure?

A

Oedema (ankles / sacral)

Elevated JVP (>4cm above sternal angle)

Hepatomegaly

Ascites (fluid build up in peritoneal cavity)

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15
Q

What would you see on the CXR of a patient with right sided heart failure?

A

Nothing, it would be normal

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16
Q

CCF related to MI and cardiomyopathy have a standard treatment pathway.

How would you treat:

  • cor pulmonale
  • valvular disease
  • fast atrial fibrillation
A

Cor pulmonale → Diuretics and O2 only

Valvular disease → Surgery

Fast AF → Digoxin (slows HR) & shock to restore sinus rhythm

17
Q

What drugs are used in the standard medical treatment for CCF?

A

Diuretics to excrete retained fluid

ACE Inhibitors

Beta blockers

Spironolactone (in severe cases)

Digoxin

Vasodilators (nitrates)

18
Q

What are some common surgical / mechanical interventions used to treat CCF?

A

Implantable cardiac defibrillators

Cardiac resynchronisation therapy

Transplantation

19
Q

What is a loop diuretic commonly used to treat CCF?

A

Furosemide

20
Q

A common side effect of loop diuretics (e.g furosemide) is hypokalaemia - what other drugs used in CCF therapy help to prevent this?

A

ACE Inhibitors

Spironolactone

21
Q

What do ACE inhibitors do?

A

Prevent the conversion of Angiotensin I → Angiotensin II by ACE.

22
Q

Name some common ACE inhibitors.

A

Captopril, enalapril, lisinopril

23
Q

An alternative to ACE Inhibitors is Angiotensin II receptor blockers (ARBs) - give some examples.

A

Losartan, valsartan

24
Q

Why would you use an ARB as opposed to an ACE inhibitor?

A

If the patient had a cough as a result of the ACE Inhibitor

25
Q

Beta blockers are good for CCF in the long term but can ___ it in the short term.

A

worsen

26
Q

What are some initial risks of using a beta blocker in someone with CCF?

A

Hypotension

Progressive dyspnoea

27
Q

Give an example of a B1 blocker used in CCF.

A

Bisoprolol

28
Q

An important quality of bisoprolol is that it is ____ - why?

A

cardioselective

Binds to B1 adrenoceptors only

29
Q

Spironolactone is an ___-receptor antagonist.

A

aldosterone

30
Q

What does ivabradine do?

A

Slows heart rate

31
Q

Ivabradine should only be used to slow the heart rate if an attempt has already been made with ___ ___.

A

beta blockers

32
Q

Research reckons that which drug will replace ACE Inhibitors in treating CCF?

A

Sacubitril-Valsartan

(Neprilysin inhibitor and ARB)

33
Q

Sacubitril-Valsartan should never be used in combination with which type of drug?

A

ACE Inhibitor

34
Q

Digoxin is used to slow down fast ___ ___.

A

atrial fibrillation

35
Q

While digoxin is useful in calming AF before it is shocked, it also has some negative effects on the heart - what are they?

A

Heart block

Ventricular arrhythmias

36
Q

What therapy should be given to a patient who is suffering acute left sided heart failure?

A

1. Sit up

2. Oxygen*

3. IV furosemide

4. IV diamorphine*

* COPD - 2 be careful, 4 absolutely not

Cardiovascular Week 5 2016/17 (5 decks)

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