Cardiac failure Flashcards
What is cardiac failure
failure of the heart to maintain the CO required to meet the bodys demands
What is congestive heart failure
Both left and right heart failure
What is meant by a low output state
heart fails to pump in response to normal exertion
What is meant by a high output state
CO is normal but there are higher metabolic needs
What ways can cardiac failure be classified by
ejection fraction
time
left/right
How is cardiac failure classified by EF
patients may have normal or abnormal LVEF
- affects around 50% of people with HF
How is LVEF measured and what defines a reduced LVEF
measured using echocardiography
<35-40%
What kind of patients usually have systolic dysfunction and what causes it
patients with reduced LVEF
ischemic heart disease
dilated cardiomyopathy
myocarditis
arrhythmias
What kind of patients usually have diastolic heart failure and what causes it
patients with preserved LVEF
hypertrophic obstructive cardiomyopathy
restrictive cardiomyopathy
cardiac tamponade
constrictive pericarditis
How is heart failure classified temporally
usually described as being acute or chronic
Acute - refers to acute exacerbation of chronic heart failure
What are the most urgent symptoms of acute heart failure
pulmonary oedema - often due to left ventricular failure
What usually causes left sided heart failure
HF-rEF and HF-pEF
due to increased left ventricular afterload or increased left ventricular preload
What usually causes right sided heart failure
increased right ventricular afterload
increased right ventricular preload
What may someone with left heart failure present with
RESP SYMPTOMS
increased heart and resp rate
arrhythmias
dyspnoea
nocturnal cough - pink frothy sputum
fatigue
What may someone with right heart failure present with
SWELLING SYMPTOMS
swelling
fatigue
raised JVP
reduced exercise tolerance
anorexia
nausea
nocturia
ascites
What criteria can be used to make a clinical diagnosis
Framingham criteria
2+ MAJORS
OR
1 major and 2 minors
What does the criteria for diagnosing heart failure include
Major
-paroxysmal nocturnal dyspnoea
-bibasal crepitation
-S3 gallop
-cardiomegaly
-increased central venous pressure
-weight loss
-neck vein distension
-acute pulmonary oedema
-hepatojugular reflux
Minor
-bilateral ankle oedema
dyspnoea on ordinary exertion
-tachycardia
-decrease in vital capacity by 1/3
-nocturnal cough
-hepatomegaly
-pleural effusion
What investigations are required for someone with suspected cardiac failure
BNP
ECG
Bloods- FBC, U&Es,LFTs,TFTs,
CXR
Transthoracic echocardiography - can calculate EF
What may someone with heart failure have on their CXR
Alveolar oedema
Kerley B-lines- signs of interstitial oedema
Cardiomegaly
dilated upper lobe vessels and upper lobe
effusion
What is management for acute cardiac failure
ABCDE APPROACH !!
give oxygen
GTN infusion - beware can cause hypotension
IV furosemide for pulmonary oedema
CPAP- if in resp failure
Inotropic agents like DOBUTAMINE- should be considered with severe left ventricular dysfunction and cardiogenic shock
What is the management for chronic heart failure
treat underlying cause , exacerbating factors, lifestyle modifications
Drugs -
first line - ACEI and beta blockers
second line - aldosterone agonist
-Spironolactone, Eplerenone, monitor potassium
SGLT 2 inhibitors
Third line ( specialist )-
Ivabradine if sinus rhythm >75/min and EF < 35%
What vaccines should someone with right sided heart failure be given
annual influenza vaccine
one-off pneumococcal vaccine
