36 - Heart Failure Flashcards
What is heart failure
Disorder prohibiting the delivery of sufficient output to meet the perfusion requirements of metabolising tissues
Causes of heart failure
Coronary heart disease
Hypertension
Cardiomyopathy
Valvular heart disease
What are some signs of heart failure
S3
alternating pulse
Tachycardia
Increased JVP
Some complications of heart failure
Intravascular thrombosis Infection Valvular dysfunction Multi-organ failure Arrhythmia Sudden death
What would a ECG look like with someone with heart failure
Inferior Q waves
Anterior T wave and ectopics
Left bundle branch block
Why would you measure BNP in heart failure
Brain natriuretic peptide
Secreted by myocardial cells in response to raised left arterial pressure (SECRETED from ventricles)
What is the function of BNP
Promotes natruresis and vasodilation
Inhibits ADH and aldosterone
What levels of BNP indicate heart failure
When levels are above 100pg/ml
How do you diagnose heart failure
Take a detailed history and examination = If no previous MI then measure BNP, if over 100 then do a doppler echo (if normal then no HF, if abnormal then HF)
if less than 100 then heart failure unlikely
If previous MI then do doppler echo straight away - if normal then no HF and if abnormal can indicate systolic/diastolic dysfunction
How do you treat systolic HF
ACE-I ARB (if ACE-Is cannot be tolerated) Beta blockers Spironolactone Angiotensin receptor neprilysin inhibitor
What devices can you give to patients with systolic HF
Cardiac re-synchronisation therapy (CRT)
+/- ICD
When would you recommend a heart transplant
Major organ failure psychological disability severe pulmonary survival (done via orthotopic transplant) prognosis is 80% year survival
What is diastolic heart failure
HeFNEF - HF with normal ejection fraction
Normal ejection fraction however impaired LV filling
due to increased chamber stiffness
Responsible for about 50% of heart failure in adults
How do you treat HeFNEF
Treat the underlying cause - Hypertension
Treat the fluid retention
RAS inhibition, BB blockers = no proven value
What is the causes of acute HF
Acute MI
Valvular disease
Cardiac arrhythmia
(Acute HF is when the symptoms of HF get suddenly worse)
