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UKMLA > Cardiac Failure > Flashcards

Cardiac Failure Flashcards

1
Q

Acute left ventricular failure

A
  • Life-threatening emergency
  • Sudden onset/worsening of HF symptoms
  • Left ventricle no longer efficiently moving blood into circulation
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2
Q

Pathophysiology of acute left ventricular failure

A
  1. Functional/structural abnormality -> reduced CO
  2. Backlog of blood in left atrium, pulmonary veins, & lungs
  3. Increased pressures, fluid leaks -> pulmonary oedema
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3
Q

Aetiology of acute left ventricular failure

A

De-novo (new):
- myocardial dysfunction
- viral myopathy
- toxins
- valvular dysfunction

Decompensated HF:
- acute coronary syndrome
- hypertensive crisis
- acute arrythmia
- valvular disease
- sepsis
- iatrogenic (e.g. aggressive fluids in elderly)

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4
Q

Iatrogenic cause of decompensated HF

A
  • Aggressive IV fluids in frail, elderly patient with known HF/impaired ventricular function
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5
Q

Managing acute left ventricular failure

SODIUM

A

SODIUM
- Sit pt. up
- Oxygen
- Diuretics (IV loop)
- IV fluids stopped!
- Underlying cause treated
- Monitoring fluid balance

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6
Q

Drugs used in severe cases of acute left ventricular failure

A
  • vasodilators (opioids, nitrates)
  • ionotropes (dobutamine - hypotensive)
  • vasopressors (hypotensive)
  • non-invasive/invasive ventilation
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7
Q

Chronic heart failure

A

Complex condition of impaired heart function, specifically the left ventricle.

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8
Q

Aetiology of chronic heart failure

Cardiovascular & non-cardiovascular

A

Cardiovascular:
- coronary artery disease
- hypertension
- valvular heart disease
- cardiomyopathies
- arrhythmias

Non-cardiovascular:
- diabetes mellitus
- renal dysfunction
- lifestyle - obesity, alcohol, smoking
- normal ageing
- infections - strep viridans

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9
Q

Symptoms of acute left ventricular failure

A
  • acute SOB
  • oedema
  • fatigue
  • ‘off-legs’
  • frothy white/pink sputum
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10
Q

Signs of acute left ventricular failure

A

General:
- tachycardia
- tachypnoea
- reduced O2 sats

Cardiac:
- raised JVP
- S3 heart sound
- displaced apex beat

Chest:
- bibasal crackles
- wheeze

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11
Q

Investigating acute left ventricular failure

A
  1. Clinical assessment (hx., exam)
  2. ECG (?ischaemia, ?arrhythmia)
  3. Bloods (?BNP - > 100 is diagnostic)
  4. ABG
  5. chest x-ray
  6. ECHO
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12
Q

CXR findings in acute left ventricular failure

A

Pulmonary oedema:
- bilateral effusions
- interlobar fissures
- kerley B lines (fluid in septal lines)

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13
Q

Classifying chronic heart failure

A

New York Heart Association (NYHA):
- Class I: no symptoms, no limitations
- Class II: no symptoms at rest, mild symptoms with ADLs
- Class III: no symptoms at rest, severe symptoms with ADLs
- Class IV: symptoms at rest, severe symptoms with ADLs

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14
Q

Symptoms of chronic heart failure

A
  • dyspnoea
  • orthopnoea
  • paroxysmal nocturnal dyspnoea
  • peripheral/sacral oedema
  • fatigue
  • cough
  • white/pink frothy sputum production
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15
Q

Signs of chronic heart failure

A

General:
- tachycardia
- tachypnoea
- hypertension
- peripheral oedema

Cardioresp:
- murmurs (if valvular)
- 3rd heart sound
- raised JVP
- displaced apex beat
- bilateral basal crackles
- cardiac cachexia

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16
Q

Investigating chronic heart failure

A
  1. clinical assessment
  2. Nt-proBNP
  3. ECG
  4. ECHO
17
Q

Interpreting NT-proBNP levels in chronic HF

A

Moderate raise (400-2000)
- specialist assessment within 6 weeks

High raise (> 2000)
- specialist assessment within 2 weeks

18
Q

Medical treatment of chronic heart failure

A

ABAL:
- ACE-i or ARB (e.g. ramipril)
- Beta-blocker (e.g. bisoprolol)
- Aldosterone antagonist (e.g. spironolactone, epleronone)
- Loop diuretic (e.g. furosemide)

Other:
- SGLT2-i (e.g. dapagliflozin)
- Digoxin
- Ivabradine

19
Q

Procedural & surgical management options for chronic heart failure

A
  • implantable cardioverter defib
  • cardiac resynchronisation therapy
  • heart transplant
  • valve repair/replacement
20
Q

Complications of chronic heart failure

A
  • arrhythmias
  • sudden cardiac death
  • ventricular remodelling
  • pulmonary oedema
  • hepatic congestion
  • renal dysfunction
  • anaemia
  • thromboembolism
  • cachexia and malnutrition

UKMLA (59 decks)

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