33. Heart Failure Flashcards
Define cardiac failure.
- A clinical syndrome comprising of dyspnoea, fatigue or fluid retention due to cardiac dysfunction either at rest or on exertion, with accompanying neurohormonal activation.
Is heart failure a final diagnosis?
- No, it’s not a final diagnosis
- term should be qualified by the underlying structural abnormality and cause e.g. heart failure due to l.ventricular systolic dysfunction (LSVD) due to ischaemic heart disease or heart failure due to severe aortic stenosis
What is the prevalence of heart failure and l. ventricular systolic dysfunction?
0.4-2% (for both heart failure and LVSD)
What does heart failure likeliness increase with?
Increases with age (mean age is mid 70s)
Is heart failure more common in men or women?
Women (on average)
What factors increase risk of cardiac heart failure? (6)
- obesity
- diabetes
- hypertension
- coronary heart disease
- hyperlipidaemia
- age
- treatment of acute MI
For which cancers is one year survival rate worse for heart failure than that of these cancers? (4)
- breast
- uterus
- prostate
- bladder
What are the biggest costs of heart failure treatment from most to least expensive? (5)
- hospital inpatient care (largest cost)
- primary care
- drugs
- hospital outpatient care
- outpatient investigations
What is the general link between heart failure and re-admission hospital rates?
has very high re-admission rates especially at early stages of cardiac failure (30% chance) (patient likely to be re-admitted again)
What are the symptoms for cardiac failure? (4)
- breathlessness
- fatigue
- oedema
- reduced exercise capacity
What are the signs for cardiac failure? (6)
- oedema
- tachycardia
- raised JVP
- chest crepitations
- 3rd heart sound (S3)
- displaced or abnormal apex beat
What can be seen on a chest x ray in heart failure patients?
Big enlarged heart (due to congestion)
Why should objective evidence of cardiac dysfunction be needed in cardiac failure patients?
- Because diagnosis is incorrect in approx. 40-50% patients.
- Symptoms not specific and signs insensitive
What are 3 main rules for diagnosing someone with cardiac failure according to European cardiology guidelines?
- Symptoms or signs of heart failure (rest or exercise)
- Objective evidence of cardiac dysfunction (and in doubtful cases)
- Response to therapy (diuretics)
What investigations need to be done to diagnose cardiac failure/dysfunction? (4)
- echo(cardiography)
- radionuclide ventriculography (RNVG/MUGA)
- MRI
- left ventriculography
- 12 lead ECG
- BNP (brain B type natriuretic peptide); blood test
Why is echo the most common screening method for cardiac failure?
No radiation and practical but wait can take up to 3-6 months
What are the pros to 12 lead ECG? (1)
- l.ventricular systolic dysfunction unlikely if ECG normal (90-95% sensitive)
What are the cons to 12 lead ECG? (1)
- problems with confidence of interpretation in primary care (must be entirely normal or else loses reliability)
What are the pros to BNP test? (Brain B type natiruretic peptide) (5)
- amino acid peptide can be measured easily in blood
- elevated in cardiac failure (therefore low BNP excluded heart failure)
- highly sensitive test for heart failure
- stable for up to 72 hours bedside testing available
- inexpensive
What are the BNP levels like in healthy hearts?
Low in healthy hearts
What does BNP naturally do in the body?
- secreted by the ventricles in response to excessive stretching of the heart
- decreases resistance and central venous pressure
- increases natriuresis (Na excretion in the urine)
- vasodilation
- increases excretion of water
- decrease in cardiac output
What does low BNP test result mean? (2)
- rules out heart failure
- rules out l.ventricular systolic dysfunction (LVSD)
What does high BNP test result mean?
There is a need for echo/cardiac assessment