Cardiac Failure Flashcards
what is the definition of cardiac failure
body’s demands>cardiac output
what is the aetiology of cardiac failure
- Low Output-commonest (low CO)
2. High Output (high demand)
what are the causes of low output in cardiac failure
- LHF
- IHD/HTN/cardiomyopathy/aortic valve disease/mitral regurgitation - RHF
- secondary to LHF/infarction/cardiomyopathy/pulmonary HTN/embolus/valve disease/chronic lung disease/tricuspid regurgitation/constrictive pericarditis/pericardial tamponade - Biventricular failure
- arrythmia/cardiomyopathy/myocarditis/drugs toxicity
what are the causes of high output (high demand) in cardiac failure
- anaemia
- pregnancy
- Paget’s disease
- hyperthyroidism
what is the epidemiology of cardiac failure
increases with age
what would be the examination findings in LHF
- tachycardia and tachypnoea
- displaced apex beat
- bibasal crackles
- 3rd heart sound (‘gallop’ rhythm for rapid ventricular filling)
- pansystolic murmur (mitral regurgitation)
what would be the examination findings in LVF
- similar to LHF
- cyanosis
- fine crackles THROUGHOUT lung
- wheeze ‘cardiac asthma’
what would be the examination findings in RHF
- raised JVP
- hepatomegaly
- ascites
- ankle/sacral pitting oedema
- tricuspid regurgitation
what history is associated with LHF
- dyspnoea
- orthopnoea
- PND
what history is associated with acute LVF
- dyspnoea
- wheeze
- cough
- pink frothy sputum
what history is associated with RHF
- ankle swelling
- weight gain from oedema
- reduced exercise tolerance
- nausea
- anorexia
what investigations would be performed in suspected cardiac failure
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))
what is the management of acute LVF
- Cardiogenic shock
in severe cardiac failure with low BP use of positive inotropes (dopamine/dobutamine) are indicated - 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)
what is the management for chronic LVF
treat cause
treat exacerbating factors
drug therapies
what are the drug therapies in management of chronic LVF
- ACE inhibitors (enalapril/perindopril/ramipril)
- B-Blockers (bisprolol/carvedilol)
ACE inhibitors and B-Blockers are additive - Loop diuretics (furosemide)
- Aldosterone antagonists (spironolactone)
- Angiotensin Receptor Blockers (candesartan)
- Hydralazine and Nitrates
- Digoxin
- N3 polyunsaturated fats
- Cardiac resynchronisation therapy
what drugs should be avoided in chronic LVF
avoid drugs that can adversely affect patients with HF due to systolic dysfunction
NSAIDs and Non-dihydropyridine CCBs (diltiazem and verapamil)
what are the complications associated with cardiac failure
respiratory failure
cardiogenic shock
death
what is the prognosis in cardiac failure
50% of severe HF patients die within 2yrs
what are common causes of HF
CAD (IHD)
HTN
valvular disease
myocarditis
what is the framingham criteria
for diagnosis of heart failure (2 major or 1 major and 2 minor)
what is the NYHA classification
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
