Cardiac Failure Flashcards
Define heart failure
Inability of the heart to pump blood to produce a cardiac output to meet the demand of the body
What are the different classifications of heart failure
Systolic vs diastolic
Right v Left
Congestive
Preserved or reduced ejection fraction (<40%)
Aetiology of heart failure
Muscular: IHD, cardiomyopathy, myocarditis HTN, Pulmonary HTN (cor pulmonale) Valvular disease Pericardial disease Arrhythmia or HOCM Drugs Thyrotoxicosis, Anaemia, pregnancy
Epidemiology of heart failure
Causes recurrent hospitalisation
Number of deaths increasing steadily
Prevalence increases with age
Presenting symptoms of heart failure
Dyspnoea (PND, orthopnoea) Fatigue Painless bilateral leg swelling Cough (nocturnal, pink frothy sputum) Wheeze Palpitations Chest pain Anorexia Nocturia Lethargy/confusion
Signs of Left heart failure
SOB Pink frothy sputum Basal crepitations that remain after coughing Hypoxia Cynoasis Fatigue
Signs of right heart failure
Raised JVP (hepatojugular reflex) Peripheral oedema Hepatosplenomegaly Fatigue Weight gain
SAWPANIC for heart failure
S3 gallop Acute pulmonary oedema Weight loss PND Abdominal reflux Neck veins distended Increased cardiac shadow Cardiomyopathies
Investigations for heart failure
TT-Echo: Depends on the type (ejection fraction)
BNP: elevated
ECG: underlying CAD, LV hypertrophy, atrial enlargement
ABG: ?resp. failure FBC: variable Troponin: risk stratification U+Es: hyponatraemia, Cr and Ur variable Glucose: risk factor (DM) TFTs: variable, may show thyrotoxicosis
CXR: alveolar oedema, Kerley B, bat wings), cardiomegaly, upper lobe diversion, pleural effusion
Management for acute exacerbation of heart failure
Likely due to pulmonary oedema
- Sit up
- Oxygen, high flow 15 L/min through non-rebreathe
- Morphine
- Furosemide
- GTN or isorbide mononitrate
If needed: pacemaker insertion, implantable cardioversion devices (ICD)
Transplant
Management for heart failure (discharge)
A - ACEi e.g. enalapril 2.5-20mg
B - Beta blocker e.g. carvedilol
C - Control rate e.g. digoxin
D - Diuretics e.g. frusemide
Offer a mineralcorticoid receptor antagonist, in addition to an ACE inhibitor (or ARB) and beta-blocker, to people who have heart failure with reduced ejection fraction if they continue to have symptoms of heart failure
+ risk factors control (statin, aspirin, DM control
±cardiac resynchronisation therapy, ICD, transplant
What lifestyle advice should be given to heart failure patients
Exercise Reduce salt intake Restrict water intake Stop alcohol Stop smoking Weight monitoring
Complications of heart failure
Pleural effusion Chronic renal insufficiency Anaemia Acute decompensation of chronic heart failure Acute renal failure Sudden cardiac death
Prognosis of heart failure
Several prognostic factors
Survival for those with end-stage HF is poor
5-year survival with stage D = 20%
