5.6 Management of Heart Disease Flashcards
Define heart disease
A state in which the heart fails to maintain an adequate circulation for the needs of the body despite a satisfactory venous filling pressure
Stages of congestive heart failure
A: no functional disease but predisposing risk factors
B: people who have no symptoms but some objective findings
C: where heart failure becomes present
D: intractable symptoms
can only move forwards through the stages
Phases of Heart failue
1: Diagnosis: decreased physical function at this time
2: Responding to treatment
3: Clinical instability
4: Poor response to treatment
5: End of life
Can move in and out of phases
Risk factors for heart failure
>60 Low physical activity Cigarette smoking Overweight Hypertension Diabetes Valvular heart disease Family history Coronary artery disease LV hypertrophy Atrial fibrillation
NYHA grading of chronic heart failure
Class 1: No limitations, asymptomatic, Metabolic equvilant >7 (2 flights of stairs)
Class 2: slight limitations on PA, symptoms of dyspnoea or palpitations, MET 5, mildly symptomatic
Class 3: symptoms on moderate exertion, MET 2-3
Class 4: Symptomatic at rest, MET 1.6
Recommendations for diagnostic investigations of CHF
All patients with suspected CHF should undergo an echo
Coronary angiography should be used with patients who have a history of exertional angina or suspected ischamiec LV dysfunction
what are the symptoms of congestive heart failure?
dyspnoea othopnea PND fatigue oedema palpitations/syncope
What is hibernating myocardiaum and why does this occur?
ischamic myocardium supplied by a narrow coronary artery in which ischemic cells remain viable but contraction is depressed - this occurs to protect the integrity of the cells
what is stunned myocardium
viable myocardium salvaged by coronary reperfusion that exhibits prolonged postischaemic dysfunction after reperfusion
What medications should be considered for CHF?
ACE inhibitors Antihypertensives Beta blockers Statins Diuretics if fluid overload
What is the non-pharmacologic treatment of CHF?
Exercise/conditioning program
Risk factor modification - smoking, alcohol
