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YR6: CARDIAC > Cardiac Failure > Flashcards

Cardiac Failure Flashcards

1
Q

Define Cardiac Failure

A

Inability of cardiac output to meet body’s demands despite NORMAL venous pressures

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2
Q

How can cardiac failure be classified by output?

A

Low output: Decreased output
High output: Increased demand

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3
Q

Which 5 conditions predispose to left heart failure?

A 
IHD
HTN
Cardiomyopathy 
Aortic valve disease  
Mitral regurgitation
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4
Q

Which 7 conditions predispose to right heart failure?

A

Secondary to left heart failure (congestive cardiac failure)
Infarction
Cardiomyopathy
Pulmonary HTN/ embolus/ valve disease
Chronic lung disease
Tricuspid regurgitation
Constrictive pericarditis/ pericardial tamponade

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5
Q

Which 4 conditions predispose to biventricular failure?

A

Arrhythmia
Cardiomyopathy (dilated or restrictive)
Myocarditis
Drug toxicity e.g. Taxanes

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6
Q

Which 6 conditions predispose to high output cardiac failure?

A 
Anaemia  
Beri beri 
Pregnancy  
Paget's disease  
Hyperthyroidism 
Arteriovenous malformation
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7
Q

Describe the epidemiology of cardiac failure

A

10% of >65 yrs

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8
Q

List 4 presenting symptoms of left heart failure

A

Dyspnoea (NYHA)
Orthopnoea
Paroxysmal nocturnal dyspnoea
Fatigue

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9
Q

What causes the presenting symptoms in left heart failure?

A

Pulmonary congestion

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10
Q

List 3 additional presenting symptoms in acute left ventricular failure

A

Wheeze
Cough
Pink frothy sputum

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11
Q

List 6 presenting symptoms in right heart failure

A 
Swollen ankles  
Fatigue  
Increased weight (due to oedema)  
Reduced exercise tolerance  
Anorexia 
Nausea
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12
Q

What are 6 signs of left heart failure?

A 
Tachycardia 
Tachypnoea 
Displaced apex beat  
Bilateral basal crackles  
S3 gallop (rapid ventricular filling)  
Pansystolic murmur (due to functional MR)
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13
Q

What are 5 additional signs in acute left ventricular failure?

A 
Cyanosis  
Peripheral shutdown  
Pulsus alternans  
Wheeze (cardiac asthma)  
Fine crackles throughout lung
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14
Q

What are 5 signs in right heart failure?

A 
Raised JVP 
Hepatomegaly  
Ascites  
Ankle/sacral pitting oedema  
Signs of functional tricuspid regurgitation
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15
Q

What bloods would be taken in cardiac failure?

A 
FBC 
U+Es 
LFTs 
CRP 
Glucose  
TFTs
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16
Q

What bloods must also be taken in acute left ventricular failure?

A 
ABG  
Troponin 
BNP 
Raised plasma BNP suggests cardiac failure  
Low plasma BNP excludes cardiac failure
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17
Q

What is seen on a CXR in acute LV failure?

A 
Alveolar oedema (bats wing shadowing)
Kerley B lines 
Cardiomegaly 
Upper lobe Diversion/ Dilated prominent upper lobe veins 
Pleural Effusion
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18
Q

What may be seen on an ECG in cardiac failure?

A

Normal
Ischaemic changes (pathological q waves, t wave inversion)
Arrhythmia or LV hypertrophy

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19
Q

What end diastolic pressures would you measure using a Swan-Ganz Catheter in cardiac failure ?

A 
RA
RV
Pulmonary artery
Pulmonary wedge
LV
20
Q

What is the management plan for all patients with acute heart failure?

A

IV loop diuretics e.g Furosemide/ Bumetanide
+/- O2: 94-98%

21
Q

When should nitrates be given in management of acute heart failure?

A

If concomitant myocardial ischaemia, severe HTN, AR or MR

22
Q

What is indicated in patients with acute heart failure and respiratory failure?

A

Continuous positive airway pressure (CPAP)

23
Q

How does CPAP benefit patients in acute heart failure?

A

Increases intrathoracic pressure which reduces venous return to the heart + lowers preload
Also decreases afterload by decreasing pressure difference between LV + extra thoracic arteries

These pressure changes increase stroke volume + promote movement of fluid from interstitial fluid compartment into the intravascular fluid compartment reducing oedema + alleviating dyspnoea

24
Q

How should patients with acute heart failure and hypotension/ cardiogenic shock be managed?

A

Inotropes e.g. Dobutamine
If severe LV dysfunction + potentially reversible cause of cardiogenic shock

Vasopressors e.g. Norepinephrine
If insufficient response to inotropes + evidence of end-organ hypoperfusion

Mechanical circulatory assistance: intra-aortic balloon counter pulsation or ventricular assist devices

25
Q

What is the first line management for chronic heart failure?

A

ACEi + BB
Start one drug at a time

26
Q

Which beta-blockers are licensed for use in chronic HF?

A

Bisoprolol
Carvedilol
Nebivolol

27
Q

What is second line management of chronic heart failure? What needs to be monitored and why?

A

Aldosterone antagonist e.g. Spironolactone/ Eplerenone
Monitor K+ as ACEi + aldosterone antagonists can cause hyperkalaemia

28
Q

What drug can be used second line in management of chronic heart failure with reduced ejection fraction?

A

SGLT-2 inhibitors: dapagliflozin, empagliflozin, canagliflozin

Reduce glucose reabsorption + increase urinary glucose excretion

29
Q

What third line therapy can be initiated by a specialist for chronic HF?

A

Ivabradine
Sacubitril-valsartan
Digoxin
Hydralazine + Nitrate
Cardiac resynchronisation therapy

30
Q

What is the criteria for using ivabradine?

A

Sinus rhythm >75 bpm
Left ventricular fraction <35%

31
Q

What is the criteria for using sacubitril valsartan?

A

LV fraction <35%
Symptomatic on ACEi/ ARBs
Must have ACEi/ ARB washout period

32
Q

What is the purpose of digoxin in heart failure? When in particular is it indicated?

A

Symptomatic relief due to inotropic properties
Strongly indicated if coexistent AF

33
Q

In which patients is hydralazine and nitrate particularly indicated?

A

Afro-caribbean

34
Q

What is the indication for cardiac resynchronisation therapy?

A

Widened QRS (LBBB)

35
Q

What non-cardiac treatment should be offered in chronic heart failure?

A

Annual influenza vaccine
One-off pneumococcal vaccine

36
Q

When treating chronic heart failure what else must you do?

A

TREAT THE CAUSE (e.g. HTN)
TREAT EXACERBATING FACTORS (e.g. anaemia)

37
Q

What must be avoided when treating patients with heart failure?

A

Drugs that could adversely affect them due to systolic dysfunction:
NSAIDs
Non-dihydropyridine CCBs e.g. Diltiazem, Verapamil

38
Q

List 3 possible complications of heart failure

A

Respiratory failure
Cardiogenic shock
Death

39
Q

What is the prognosis for heart failure?

A

50% with cardiac failure die within 2 years

40
Q

What conservative management advice is used for chronic heart failure?

A

Stop smoking
Stop drinking alcohol
Decrease salt intake
Optimise weight + nutrition

41
Q

Describe left heart failure

A

Dysfunction associated with LV

42
Q

Describe right heart failure

A

Dysfunction associated with the RV

Often a result of left-sided failure.

43
Q

How can heart failure be classified by time course?

A

Acute: Rapid onset
Chronic: Slow onset

44
Q

What are the 2 types of left heart failure?

A

Systolic: LV loses its ability to contract normally
Diastolic: LV loses its ability to relax normally

45
Q

Why perform an echocardiogram in cardiac failure?

A

To assess ventricular contraction.
If LV ejection fraction < 40%: systolic dysfunction.
Diastolic dysfunction: reduced compliance leading to a restrictive filling defect.

46
Q

When are nitrates particularly indicated in acute cardiac failure?

A

Severe HTN
Concurrent myocardial ischaemia/ regurgitant aortic/ mitral valve disease

47
Q

What is the MOA of nitrates that benefits patients in acute cardiac failure?

A

Dilate coronary arteries, enhancing blood flow to myocardium
Vasodilatory effects reduce preload + afterload

YR6: CARDIAC (41 decks)

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