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Year One - Cardiovascular System > Acute Heart Failure > Flashcards

Acute Heart Failure Flashcards

1
Q

What is acute heart failure?

A

It is a condition in which the cardiovascular system fails to pump sufficient quantities of blood to meet the physiological demands of the body

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2
Q

Acute heart failure causes a back flow of blood in which three locations?

A

Left atrium

Pulmonary veins

Lungs

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3
Q

What are the five classifications of acute heart failure?

A

Systolic heart failure

Diastolic heart failure

Left sided heart failure

Right sided heart failure

High output heart failure

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4
Q

What is another term for systolic heart failure?

A

HFrEF

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5
Q

What is systolic heart failure?

A

It is inability of the ventricle to contract normally during systole

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6
Q

What cardiac output and ejection fraction results indicate systolic heart failure?

A

CO - Decreased

Ejection Fraction - < 40%

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7
Q

What is another term for diastolic heart failure?

A

HFpEF

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8
Q

What is diastolic heart failure?

A

It is inability of the ventricle to relax normally during diastole

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9
Q

What ejection fraction results indicate diastolic heart failure?

A

Ejection Fraction - > 50%

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10
Q

What does diastolic heart failure commonly progress to?

A

Systolic heart failure

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11
Q

What is left sided heart failure?

A

It is inability of the left side of the heart fails to pump sufficient amounts of blood to the body

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12
Q

What are the two general causes of left sided heart failure?

A

Increased left ventricular afterload - due to arterial hypertension or aortic stenosis

Increased left ventricular preload - due to aortic regurgitation

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13
Q

What are the five clinical features of left sided heart failure?

A

Pulmonary Oedema

Dyspnoea

Orthopnoea

Paroxysmal Nocturnal Dyspnoea

Bibasal Fine Crackles

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14
Q

What is right sided heart failure?

A

It is inability of the right side of the heart fails to pump sufficient amounts of blood to the lungs

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15
Q

What are the two general causes of right sided heart failure?

A

Increased right ventricular afterload - due to pulmonary hypertension

Increased right ventricular preload - due to tricuspid regurgitation

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16
Q

What are the five clinical features of right sided heart failure?

A

Peripheral Oedema

Raised JVP

Hepatosplenomegaly

Weight Gain

Anorexia

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17
Q

What is high output heart failure?

A

It refers to a situation where a normal heart is unable to pump enough blood to meet the metabolic needs of the body

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18
Q

What are the six causes of high output heart failure?

A

Anaemia

Arteriovenous Malformation

Paget’s disease

Pregnancy

Thyrotoxicosis

Thiamine Deficiency

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19
Q

What are the four causes of systolic heart failure?

A

Ischaemic heart disease

Dilated cardiomyopathy

Myocarditis

Arrhythmias

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20
Q

What are the four causes of diastolic heart failure?

A

Hypertrophic obstructive cardiomyopathy

Restrictive cardiomyopathy

Cardiac tamponade

Constrictive pericarditis

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21
Q

What are the six symptoms of acute heart failure?

A

Dyspnoea on Exertion

Cough with White/Pink Sputum

Orthopnoea

Paroxysmal Nocturnal Dyspnoea

Peripheral Oedema

Ascites

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22
Q

What are the six signs of acute heart failure?

A

Tachycardia

Tachypnoea

Hypoxemia

3rd Heart Sound

Bilateral Basal Cracks

Increased JVP

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23
Q

What system is used to diagnose acute heart failure?

A

Framingham Criteria for Congestive Heart Failure

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24
Q

What score in the Framingham Criteria for Congestive Heart Failure obtains a diagnosis of heart failure?

A

2 major criteria

OR

1 major criterion and 2 minor criteria

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25
Q

What are the five major criteria in the ‘Framingham Criteria for Congestive Heart Failure’?

A

PAINS

Paroxysmal Nocturnal Dyspnoea

Acute Pulmonary Oedema

Increased Heart Size/Increased Central Venous Pressure

Neck Vein Dilatation

S3 Gallop

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26
Q

What are the four minor criteria in the ‘Framingham Criteria for Congestive Heart Failure’?

A

PAIN

Pleural Effusion

Ankle Oedema (Bilateral)

Increased Heart Rate > 120bpm

Nocturnal Cough

27
Q

What are the three investigations used to diagnose acute heart failure?

A

Blood tests

ECHO scan

Chest x-ray

28
Q

What blood test is used to diagnose acute heart failure?

A

BNP

29
Q

What is BNP?

A

It is a hormone that is released from the heart ventricles when the myocardium is stretched beyond normal range

30
Q

What is the function of BNP?

A

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

31
Q

What BNP result indicates acute heart failure?

A

Elevated > 100mg/litre

32
Q

What does an elevated BNP result indicate?

A

It indicates that the heart is overloaded beyond its normal capacity to pump effectively

33
Q

What investigation is conducted to diagnose acute heart failure following a positive BNP result?

A

ECHO scan

34
Q

How are ECHO scans used to diagnose acute heart failure?

A

They are used to assess cardiac function, allowing measurement of the LV ejection fraction

35
Q

What is the LV ejection fraction?

A

This is the percentage of blood in the ventricle that is pumped out with each ventricular contraction

36
Q

What LV ejection fraction result indicates acute heart failure?

A

Decreased

37
Q

What is the normal LV ejection fraction?

A

50 - 80%

38
Q

What LV ejection fraction indicates mild heart failure?

A

40 - 50%

39
Q

What LV ejection fraction indicates moderate heart failure?

A

30 - 40%

40
Q

What LV ejection fraction indicates severe heart failure?

A

< 30%

41
Q

What are the five signs of acute heart failure on CXR?

A

ABCDE

Alveolar Oedema

Kerley B Lines

Cardiomegaly

Dilated Upper Lobe Vessels

Pleural Effusion

42
Q

What is the conservative management option of acute heart failure?

A

We advise patients to sit upright

43
Q

Why do we advise acute heart failure patients to sit upright?

A

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

44
Q

When should oxygen be administered to acute heart failure patients?

A

Oxygen saturations < 94%

Respiratory failure

45
Q

In what two ways do we administer oxygen to manage acute heart failure?

A

We administer 15L high flow oxygen

Continuous positive airway pressure (CPAP)

46
Q

What is CPAP?

A

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

47
Q

When is CPAP used to manage acute heart failure?

A

Respiratory failure, in which there is no response to high flow oxygen

48
Q

In which patient group should we be careful in administrating oxygen to?

A

COPD patients

49
Q

What are the two pharmacological management options of acute heart failure?

A

Loop Diuretics

Vasodilators

50
Q

What is the first line management option of acute heart failure?

A

IV loop diuretics

51
Q

What is the mechanism of action of loop diuretics?

A

They reduce the circulating volume and therefore allow the heart to pump more effectively

52
Q

What are the two loop diuretics used to manage acute heart failure?

A

Furosemide

Bumetanide

53
Q

What is the mechanism of action of vasodilators?

A

They are drugs that dilate blood vessels and decrease blood pressure

54
Q

What vasodilators are used to manage acute heart failure?

A

Nitrates

55
Q

When are vasodilators administered to acute heart failure patients?

A

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

56
Q

What are the two pharmacological management options of acute heart failure - associated with hypotension or cardiogenic shock?

A

Inotropes

Vasopressors

57
Q

What is the mechanism of action of inotropes?

A

They are drugs that strengthen the force of heart contractions

58
Q

What two inotropes are used to manage acute heart failure?

A

Adrenaline

Dobutamine

59
Q

When are inotropes administered to acute heart failure patients?

A

They should be considered in patients with severe left ventricular dysfunction who have potentially reversible cardiogenic shock

60
Q

What is the mechanism of action of vasopressors?

A

They are drugs that constrict blood vessels and raise blood pressure

61
Q

What vasopressor is used to manage acute heart failure?

A

Norepinephrine

62
Q

When are vasopressors administered to acute heart failure patients?

A

They should be considered in patients who have insufficiently responded to inotropes and have evidence of end-organ hypoperfusion

63
Q

Which drug class is contraindicated in the management of acute heart failure?

A

Betablockers

Year One - Cardiovascular System (20 decks)

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