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Z Year3 Cardio Conditions > Cardiac Failure > Flashcards

Cardiac Failure Flashcards

1
Q

What are the 3 categories for causes of LHF?

A
  • Valvular
  • Muscular
  • Systemic
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2
Q

What is cardiac failure also called?

A
  • Chronic congestive heart failure

- Congestive heart disease

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3
Q

What are some key RF for cardiac failure? (lots of others to)

A
  1. History of MI
  2. DM
  3. Dyslipidaemia
  4. Old age
  5. Male sex
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4
Q

What are some differential diagnosis of cardiac failure?

A
  1. Ageing/physical inactivity
  2. COPD/pulmonary fibrosis
  3. Pneumonia
  4. Pulmonary embolism (PE)
  5. Post-partum cardiomyopathy (PPCM)
  6. Cirrhosis
  7. Nephrotic syndrome
  8. Pericardial disease
  9. Venous stasis
  10. Deep venous thrombosis
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5
Q

What special test is used to diagnose heart failure?

A

transthoracic echocardigrsm

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6
Q

What might you see on a transthroacic echocardiogram in systolic heart failure?

A

depressed and dilated left and/or right ventricle with low ejection fraction

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7
Q

What might you see on a transthroacic echocardiogram in diastolic heart failure?

A
  1. LVEF normal but LVH

2. abnormal diastolic filling patterns

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8
Q

What imaging is used to investigate in cardiac failure?

A
  1. ECG

2. CXR

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9
Q

What may you use in an ecg in cardiac failure?

A
  1. evidence of underlying coronary artery disease
  2. left ventricular hypertrophy, or atrial enlargement
  3. may be conduction abnormalities and abnormal QRS duration
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10
Q

What might the CXR show in cardiac failure?

A
  1. Alveolar oedema
  2. B lines (kerley)
  3. Cardiomegaly
  4. Dilated upper lobe vessels
  5. Diverted upper lobe
  6. Effusion (transudative pleural effusion)
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11
Q

What bloods would you order for cardiac failure?

A
  1. BNP/NT-pro-BNP levels
  2. FBC
  3. Serum electrolytes (inc calcium and magensium)
  4. Serum creatinine, blood urea nitrogen
  5. Blood glucose
  6. LFT
  7. TFTs + TSH
  8. Blood lipids
  9. Serum ferritin
  10. Transferrin saturation
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12
Q

What might you find BNP/NT-pro-BNP levels in cardiac failure?

A

elevated

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13
Q

Why do you do an fbc for cardiac failure?

A

anaemia and high lymphocyte percentage – strong RF and show poor prognostic

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14
Q

What would you find in serum electrolytes with cardiac failure?

A

decreased sodium and altered potassium

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15
Q

What would you find in serum creatinine, blood urea nitrogen in cardiac failure?

A

normal to elevated can show:

  • tissue perfusion
  • fluid status
  • rules out renal disease
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16
Q

Why do you measure blood glucose in cardiac failure?

A

see if diabetes

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17
Q

Why do you measure LFTs in cardiac failure?

A

can show abdominal congestion

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18
Q

Why do you measure TFTs and TSH in cardiac failure?

A

as hypo/hyperthyroidism can cause heart failure

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19
Q

Why do you measure blood lipids in cardiac failure?

A
  • elevated in dyslipidaemia

- decreased in end-stage heart failure, especially in the presence of cardiac cachexia

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20
Q

Why do you measure serum ferritin and transferrin saturation in cardiac failure?

A

evaluation of cardiomyopathy due to iron overload cardiomyopathy/haemochromatosis

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21
Q

What is the ejection fraction like in systolic heart failure?

A

low (less than 50%)

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22
Q

What is the ejection fraction in diastolic heart failure?

A

normal (50-70)

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23
Q

In heart failure what happens with left or right?

A

where primary issue is, as one can cause the other as it is a system

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24
Q

What type of heart failure is left sided mostly?

A

systolic

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25
Q

What is the most common cause of left sided heart failure (systolic)?

A
  • ischaemic heart disease
  • long standing hypertension
  • dilated cardiomyopathy
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26
Q

What is the most common cause of left sided heart failure (diastolic)

A
  1. long standing hypertension
  2. aortic stenosis
  3. hypertrophic cardiomyopathy
  4. restrictive cardiomyopathy
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27
Q

Why is there fluid build up in cardiac failure?

A
  1. less blood to kidneys
  2. renin-angiotensin system activated
  3. fluid retention
  4. leaks from blood vessels
  5. fluid build up
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28
Q

Why do patients with cardiac failure have dyspnea and orthopnea and crackles?

A

pulmonary odema

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29
Q

What type of cells may be seen with a cardiac failure patient?

A

hemosiderin-laden macrophages

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30
Q

What is right sided heart failure usually caused by?

A

left sided heart failure (becomes biventricular heart failure)

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31
Q

What is isolated right sided heart failure causes by?

A
  1. left to right cardiac shunt (e.g. atrial septal defect, ventircular septal defect)
  2. cor pulmonale (chronic lung disease lead to right sided hypertrophy and failure)
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32
Q

Why does a left to right shunt cause isolated right side heart failure?

A
  1. high pressure to low pressure
  2. increased fluid volume on right side
  3. lead to concentric hypertrophy
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33
Q

What would concentric hypertrophy cause?

A
  1. ischaemia (systolic dysfunction)

2. smaller volume (diastolic dysfunction)

34
Q

Where does the fluid go in left and right sided heart failure?

A
  1. left: lungs

2. right: body

35
Q

How can you tell if right sided failure?

A
  1. systemic vein congestion
  2. JVP distention (enlarged)
  3. Hepatospenomegaly
  4. Cardiac cirrhosis and liver failure
  5. Ascites
  6. Pitting edema in leg or sacrum
36
Q

What can heart failure lead to? How is this treated?

A

arrhythmias (cardiac resynchronisation therapy or VAD)

37
Q

How do you treat end stage heart failure?

A

transplant

38
Q

What is a severe left ventricular heart failure sign?

A

pulsus alternana

39
Q

What does left sided heart failure causes?

A

dyspnoea and orthpnoea

40
Q

What is the 1st line treatment for cardiac failure with tolerance to ACE inhibitors and then if don’t tolerate?

A
  • ACE inhibitor or sacubitril / valsartan

- Can switch to ARB if not tolerable (cough)

41
Q

What would you add to the treatment of cardiac failure with tolerance to ACE inhibitors and why?

A

beta blockers to reduce O2 demand on heart

-bisoprolol, carvedilol

42
Q

What adjunct may you use for the treatment of cardiac failure with tolerance to ACE inhibitors?

A
  1. diuretic
  2. aldosterone antagonist
  3. hydralaxine + isosoribide dinitrate
  4. Digoxin
  5. Ivabradine
  6. Vasopressin antagonist
43
Q

What is the 1st line treatment for cardiac failure with intolerance to ACE inhibitors?

A
  1. beta blocker

2. angiotensin-II receptor antagonist

44
Q

What would you add to the treatment of cardiac failure with intolerance to ACE inhibitors?

A

lifestyle changes

45
Q

What adjunct would you use with the treatment of cardiac failure with intolerance to ACE inhibitors?

A
  1. Diuretic
  2. aldosterone antagonist
  3. hydralazine + isosorbide dinitrate
  4. digoxin
  5. ivabradine
  6. vasopressin antagonist
46
Q

What is the 2nd line treatment for cardiac failure with intolerance to ACE inihibtors?

A 
2nd line: hydralazine + isosorbide dinitrate 
Plus: beta blocker + lifestyle changes
Adjunct:
1. diuretic
2. aldosterone antagonist
3. digoxin
4. ivabradine
5. vasopressin antagonist
47
Q

What is the treatment for ongoing cardiac failure with LVEF <35% with no LBBB?

A

1st line: implantable cardioverter-defibrillator (ICD)
2nd line: mechanical circulatory support
3rd line: cardiac transplantation

48
Q

What is the treatment for ongoing cardiac failure with LVEF <35% with LBBB?

A

1st line: cardiac re-synchronisation therapy with biventricular pacemaker (CRT-P) / cardiac resynchronisation therapy defibrillator (CRT-D)
2nd line: left ventricular assist device (LVAD)
3rd line: cardiac transplantation

49
Q

What are the possible complications of cardiac failure?

A
  1. Pleural effusion
  2. Chronic kidney disease
  3. Anaemia
  4. Acute decompensation of chronic heart failure
  5. Acute kidney injury
  6. Sudden cardiac death
50
Q

What criteria and classifications are used for cardiac failure?

A
  1. Framingham criterion

2. New York Heart Association classification

51
Q

What is the prognosis like for cardiac failure?

A

25-50% dying within 5 years of diagnosis

52
Q

What are the valvular causes of left heart failure?

A
  1. Aortic stenosis
  2. Aortic regurgitation
  3. Mitral regurgitation
53
Q

What are the muscular causes of left heart failure?

A
  1. Ischaemia (IHD)
  2. Cardiomyopathy
  3. Myocarditis
  4. Arrythmias (AF)
54
Q

What are the systemic causes of left heart failure?

A
  1. Hypertension
  2. Amyloidosis
  3. Drugs (coke, chemo)
55
Q

What are the 2 categories for causes of right heart failure?

A
  • lungs

- valvular

56
Q

What are the lung causes of RHF?

A
  1. Pulmonary hypertension (cor pulmonale)
  2. PE
  3. Chronic lung disease e.g. interstitial lung disease, cystic fibrosis
57
Q

What are the valvular causes of RHF?

A
  1. Tricuspid regurg

2. Pulmonary valve disease

58
Q

What two types of things can result in cardiac failure?

A
  • low output state

- high output state

59
Q

What is a low output state?

A

heart fails to pump in response to normal exertion – low cardiac output

60
Q

What is a high output state?

A

cardiac output normal but metabolic needs change e.g. preggers, anaemia, hyperthyroidism

61
Q

Where does the left side of the heart recieve blood from?

A

pulmonary vein

62
Q

What type of symptoms are in LHF?

A

fluid accumulate in lungs so likely to get RESP symptoms – PULMONARY SYSTEM

63
Q

What are symptoms for LHF?

A
  1. Dyspnoea
  2. Paroxysmal nocturnal dyspnoea (PND)
  3. Exertional Dyspnoes
  4. Orthpnoea
  5. Nocturnal cough (PINK FORTHY SPUTM -PULMONARY OEDEMA)
  6. Fatigue
64
Q

What are the heart signs in LHF?

A
  1. Increased HR and RR
  2. Irregularly irregular heartbeat
  3. Pulsus alternans
  4. Displaced apex beat
  5. S3 gallop rhythm,
  6. S4 in severe HF
  7. Murmur: AS, MR, AR
65
Q

What are the lung signs in LHF?

A
  1. Fine-end inspiratory crackles at lung bases (pulmonary oedema)
  2. Wheeze (cardiac asthma)
66
Q

Where does the right side of the heart receive blood from?

A

vena cava

67
Q

What type of symptoms are in RHF?

A

fluid accumulate peripheries so SWELLING signs – as receives from Vena Cava - SYSTEMIC

68
Q

What are symptoms of RHF?

A
  1. Fatigue
  2. Reduced exercise tolerance
  3. Anorexia
  4. Nausea
  5. Nocturia
69
Q

What are signs for RHF?

A
  1. Face: neck swelling
  2. Neck: increase JVP
  3. Heart/chest: TR murmur, increase HR and increase RR
  4. Abdomen: ascites, hepatomegaly
  5. Other: ankle and sacral pitting oedema
70
Q

Why do you do a transthroacic ecocardiogram?

A
  1. Visualise structure and function of heart(can show cause of HF)
  2. Can calculate ejection fraction (EF): % of blood present in LV that gets pumped during systole
    Normal is 50-70%
71
Q

What is HF with EF<40%?

A

HF with reduced ejection fraction (HFrEF) (previously called systolic HF), indicated inability of ventricle to contract normally)

72
Q

What is HF with EF>50%?

A

HF with preserved ejection fraction (HFpEF), previously called diastolic HF, indicates inability of ventricle to relax and fill normally

73
Q

How is the diagnosis of HF made?

A

clinical diagnosis made using Framingham Criteria

2+ majors or 1 major and 2 minors

74
Q

What is some of the major criteria?

A
  1. Paroxysmal nocturnal dyspnoea
  2. Bibasal crepitations
  3. S3 gallop
  4. Cardiomegaly
  5. Increased central venous pressure
  6. Weight loss
  7. Neck Vein distension
  8. Acute Pulmonary oedema
  9. Hepatojugular reflex
75
Q

What is some of the minor criteria?

A
  1. Bilateral ankle oedema
  2. Dyspnoea on ordinary exertion
  3. Tachycardia
  4. Decrease in vital capacity by 1/3
  5. Nocturnal cough
  6. Hepatosplenomegaly
  7. Pleural effusion
76
Q

When do you use diuretics and which ones?

A
  • use if evidence of fluid retention
  • Loop diuretics e.g. furosemide
  • Aldosterone antagonists e.g. spironolactone
77
Q

When do you use hydralazine + nitrates in heart failure?

A

afro-caribeban patients

78
Q

How does digoxin help with cardiac failure?

A

positive inotrope (strengthen heart contraction), improve symptoms BUT NOT MORTALITY

79
Q

How is cardiac resynchronisation therapy is used?

A

aims to improve timings of contraction of atria and ventricles

80
Q

What is the treatment for acute HF?

A
  1. Sit patient upright
  2. 60-100% oxygen
  3. IV diamorphine 2.5-5mg
  4. GTN infusion
  5. IV furosemide 40-80mg (can alleviate pulmonary oedema if they have that)

Z Year3 Cardio Conditions (22 decks)

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