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Year 5 Cardiology > Cardiac Failure > Flashcards

Cardiac Failure Flashcards

1
Q

what is the definition of cardiac failure

A

body’s demands>cardiac output

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2
Q

what is the aetiology of cardiac failure

A
  1. Low Output-commonest (low CO)

2. High Output (high demand)

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3
Q

what are the causes of low output in cardiac failure

A
  1. LHF
    - IHD/HTN/cardiomyopathy/aortic valve disease/mitral regurgitation
  2. RHF
    - secondary to LHF/infarction/cardiomyopathy/pulmonary HTN/embolus/valve disease/chronic lung disease/tricuspid regurgitation/constrictive pericarditis/pericardial tamponade
  3. Biventricular failure
    - arrythmia/cardiomyopathy/myocarditis/drugs toxicity
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4
Q

what are the causes of high output (high demand) in cardiac failure

A
  1. anaemia
  2. pregnancy
  3. Paget’s disease
  4. hyperthyroidism
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5
Q

what is the epidemiology of cardiac failure

A

increases with age

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6
Q

what would be the examination findings in LHF

A
  • tachycardia and tachypnoea
  • displaced apex beat
  • bibasal crackles
  • 3rd heart sound (‘gallop’ rhythm for rapid ventricular filling)
  • pansystolic murmur (mitral regurgitation)
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7
Q

what would be the examination findings in LVF

A
  • similar to LHF
  • cyanosis
  • fine crackles THROUGHOUT lung
  • wheeze ‘cardiac asthma’
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8
Q

what would be the examination findings in RHF

A
  • raised JVP
  • hepatomegaly
  • ascites
  • ankle/sacral pitting oedema
  • tricuspid regurgitation
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9
Q

what history is associated with LHF

A
  • dyspnoea
  • orthopnoea
  • PND
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10
Q

what history is associated with acute LVF

A
  • dyspnoea
  • wheeze
  • cough
  • pink frothy sputum
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11
Q

what history is associated with RHF

A
  • ankle swelling
  • weight gain from oedema
  • reduced exercise tolerance
  • nausea
  • anorexia
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12
Q

what investigations would be performed in suspected cardiac failure

A 
1 TTE (identifies cardiac dysfunction, systolic HF indicated by LVEF <40%, diastolic HF indicate by abnormal filling)
2 Bloods (raised BNP) (FBC (anaemia is RF), UEs, LFTs, glucose, lipids, TFTs)
3 CXR (Alveolar oedema, B-lines for interstitial oedema, Cardiomegaly, Diversion and Dilation of upper lobe vessels, Effusion pleural)
4 ECG (normal/ischaemic changes (ST depression))
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13
Q

what is the management of acute LVF

A
  1. Cardiogenic shock
    in severe cardiac failure with low BP use of positive inotropes (dopamine/dobutamine) are indicated
  2. Pulmonary oedema
    sit patient up, 60-100% O2, consider CPAP to keep airways open
    1st line therapies (diamorphine, GTN, IV furosemide)
    monitoring
    treat cause (MI/arrythmia)
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14
Q

what is the management for chronic LVF

A

treat cause
treat exacerbating factors
drug therapies

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15
Q

what are the drug therapies in management of chronic LVF

A
  1. ACE inhibitors (enalapril/perindopril/ramipril)
  2. B-Blockers (bisprolol/carvedilol)
    ACE inhibitors and B-Blockers are additive
  3. Loop diuretics (furosemide)
  4. Aldosterone antagonists (spironolactone)
  5. Angiotensin Receptor Blockers (candesartan)
  6. Hydralazine and Nitrates
  7. Digoxin
  8. N3 polyunsaturated fats
  9. Cardiac resynchronisation therapy
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16
Q

what drugs should be avoided in chronic LVF

A

avoid drugs that can adversely affect patients with HF due to systolic dysfunction
NSAIDs and Non-dihydropyridine CCBs (diltiazem and verapamil)

17
Q

what are the complications associated with cardiac failure

A

respiratory failure
cardiogenic shock
death

18
Q

what is the prognosis in cardiac failure

A

50% of severe HF patients die within 2yrs

19
Q

what are common causes of HF

A

CAD (IHD)
HTN
valvular disease
myocarditis

20
Q

what is the framingham criteria

A

for diagnosis of heart failure (2 major or 1 major and 2 minor)

21
Q

what is the NYHA classification

A

categorises HF

I: no limitation of physical activity
II: mild limitation of physical activity
III: limitation of physical activity
IV: symptoms occur even at rest

Year 5 Cardiology (42 decks)

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