Acute Heart Failure Flashcards
What is acute heart failure?
It is a condition in which the cardiovascular system fails to pump sufficient quantities of blood to meet the physiological demands of the body
Acute heart failure causes a back flow of blood in which three locations?
Left atrium
Pulmonary veins
Lungs
What are the five classifications of acute heart failure?
Systolic heart failure
Diastolic heart failure
Left sided heart failure
Right sided heart failure
High output heart failure
What is another term for systolic heart failure?
HFrEF
What is systolic heart failure?
It is inability of the ventricle to contract normally during systole
What cardiac output and ejection fraction results indicate systolic heart failure?
CO - Decreased
Ejection Fraction - < 40%
What is another term for diastolic heart failure?
HFpEF
What is diastolic heart failure?
It is inability of the ventricle to relax normally during diastole
What ejection fraction results indicate diastolic heart failure?
Ejection Fraction - > 50%
What does diastolic heart failure commonly progress to?
Systolic heart failure
What is left sided heart failure?
It is inability of the left side of the heart fails to pump sufficient amounts of blood to the body
What are the two general causes of left sided heart failure?
Increased left ventricular afterload - due to arterial hypertension or aortic stenosis
Increased left ventricular preload - due to aortic regurgitation
What are the five clinical features of left sided heart failure?
Pulmonary Oedema
Dyspnoea
Orthopnoea
Paroxysmal Nocturnal Dyspnoea
Bibasal Fine Crackles
What is right sided heart failure?
It is inability of the right side of the heart fails to pump sufficient amounts of blood to the lungs
What are the two general causes of right sided heart failure?
Increased right ventricular afterload - due to pulmonary hypertension
Increased right ventricular preload - due to tricuspid regurgitation
What are the five clinical features of right sided heart failure?
Peripheral Oedema
Raised JVP
Hepatosplenomegaly
Weight Gain
Anorexia
What is high output heart failure?
It refers to a situation where a normal heart is unable to pump enough blood to meet the metabolic needs of the body
What are the six causes of high output heart failure?
Anaemia
Arteriovenous Malformation
Paget’s disease
Pregnancy
Thyrotoxicosis
Thiamine Deficiency
What are the four causes of systolic heart failure?
Ischaemic heart disease
Dilated cardiomyopathy
Myocarditis
Arrhythmias
What are the four causes of diastolic heart failure?
Hypertrophic obstructive cardiomyopathy
Restrictive cardiomyopathy
Cardiac tamponade
Constrictive pericarditis
What are the six symptoms of acute heart failure?
Dyspnoea on Exertion
Cough with White/Pink Sputum
Orthopnoea
Paroxysmal Nocturnal Dyspnoea
Peripheral Oedema
Ascites
What are the six signs of acute heart failure?
Tachycardia
Tachypnoea
Hypoxemia
3rd Heart Sound
Bilateral Basal Cracks
Increased JVP
What system is used to diagnose acute heart failure?
Framingham Criteria for Congestive Heart Failure
What score in the Framingham Criteria for Congestive Heart Failure obtains a diagnosis of heart failure?
2 major criteria
OR
1 major criterion and 2 minor criteria
What are the five major criteria in the ‘Framingham Criteria for Congestive Heart Failure’?
PAINS
Paroxysmal Nocturnal Dyspnoea
Acute Pulmonary Oedema
Increased Heart Size/Increased Central Venous Pressure
Neck Vein Dilatation
S3 Gallop
What are the four minor criteria in the ‘Framingham Criteria for Congestive Heart Failure’?
PAIN
Pleural Effusion
Ankle Oedema (Bilateral)
Increased Heart Rate > 120bpm
Nocturnal Cough
What are the three investigations used to diagnose acute heart failure?
Blood tests
ECHO scan
Chest x-ray
What blood test is used to diagnose acute heart failure?
BNP
What is BNP?
It is a hormone that is released from the heart ventricles when the myocardium is stretched beyond normal range
What is the function of BNP?
To relax the smooth muscles in blood vessels, which reduces the systemic vascular resistance and makes it easier for the heart to pump blood
To promote the excretion of water in urine, which reduces circulating volume and improves cardiac function
What BNP result indicates acute heart failure?
Elevated > 100mg/litre
What does an elevated BNP result indicate?
It indicates that the heart is overloaded beyond its normal capacity to pump effectively
What investigation is conducted to diagnose acute heart failure following a positive BNP result?
ECHO scan
How are ECHO scans used to diagnose acute heart failure?
They are used to assess cardiac function, allowing measurement of the LV ejection fraction
What is the LV ejection fraction?
This is the percentage of blood in the ventricle that is pumped out with each ventricular contraction
What LV ejection fraction result indicates acute heart failure?
Decreased
What is the normal LV ejection fraction?
50 - 80%
What LV ejection fraction indicates mild heart failure?
40 - 50%
What LV ejection fraction indicates moderate heart failure?
30 - 40%
What LV ejection fraction indicates severe heart failure?
< 30%
What are the five signs of acute heart failure on CXR?
ABCDE
Alveolar Oedema
Kerley B Lines
Cardiomegaly
Dilated Upper Lobe Vessels
Pleural Effusion
What is the conservative management option of acute heart failure?
We advise patients to sit upright
Why do we advise acute heart failure patients to sit upright?
This is due to the fact that when lying flat, the fluid in the lung’s spreads to larger area
However, when sitting upright, gravity results in the movement of fluid to the base of the lung, leaving the upper lungs clear for gas exchange
When should oxygen be administered to acute heart failure patients?
Oxygen saturations < 94%
Respiratory failure
In what two ways do we administer oxygen to manage acute heart failure?
We administer 15L high flow oxygen
Continuous positive airway pressure (CPAP)
What is CPAP?
This involves a tight fitting mask to forcefully blow air into the patient’s lungs
This helps to open the airways and alveoli to improve gas exchange
When is CPAP used to manage acute heart failure?
Respiratory failure, in which there is no response to high flow oxygen
In which patient group should we be careful in administrating oxygen to?
COPD patients
What are the two pharmacological management options of acute heart failure?
Loop Diuretics
Vasodilators
What is the first line management option of acute heart failure?
IV loop diuretics
What is the mechanism of action of loop diuretics?
They reduce the circulating volume and therefore allow the heart to pump more effectively
What are the two loop diuretics used to manage acute heart failure?
Furosemide
Bumetanide
What is the mechanism of action of vasodilators?
They are drugs that dilate blood vessels and decrease blood pressure
What vasodilators are used to manage acute heart failure?
Nitrates
When are vasodilators administered to acute heart failure patients?
They should not be routinely given to all acute heart failure patients
However, they may be considered in patients with associated myocardial infarction, severe hypertension or valve disease
What are the two pharmacological management options of acute heart failure - associated with hypotension or cardiogenic shock?
Inotropes
Vasopressors
What is the mechanism of action of inotropes?
They are drugs that strengthen the force of heart contractions
What two inotropes are used to manage acute heart failure?
Adrenaline
Dobutamine
When are inotropes administered to acute heart failure patients?
They should be considered in patients with severe left ventricular dysfunction who have potentially reversible cardiogenic shock
What is the mechanism of action of vasopressors?
They are drugs that constrict blood vessels and raise blood pressure
What vasopressor is used to manage acute heart failure?
Norepinephrine
When are vasopressors administered to acute heart failure patients?
They should be considered in patients who have insufficiently responded to inotropes and have evidence of end-organ hypoperfusion
Which drug class is contraindicated in the management of acute heart failure?
Betablockers
