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Cardiology > Cardiac Failure > Flashcards

Cardiac Failure Flashcards

1
Q

Define chronic HF?

A

Long term conditionin which the heart fails to maintain an adequate circulation for the needs of the body

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2
Q

Define acute heart failure?

A

Rapid onset symptoms and signs of heart failure, requiring urgent management

Caused by acute coronary syndrome OR decompensation of chronic HF

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3
Q

outline the classification of HF anatomically?

A

Left Heart Failure (LHF)

Right Heart Failure (RHF)

LHF + RHF = Congestive Heart Failure(CHF)

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4
Q

outline the classification of heart failure by cardiac output?

A

Low Output State: Heart fails to pump in response to normal exertion -> low CO

High Output State: CO is normal but higher metabolic needs e.g. pregnancy, anaemia, hyperthyroidism

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5
Q

what are the causes of chronic left HF?

A

Valvular

  • Aortic stenosis
  • Aortic regurgitation
  • Mitral regurgitation

Muscular

  • Ischaemia (IHD)
  • Cardiomyopathy
  • Myocarditis
  • Arrhythmias (AF)

Systemic

  • Hypertension
  • Amyloidosis
  • Drugs (e.g. cocaine, chemo)
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6
Q

what are the causes of chronic right HF?

A

Lungs

  • Pulmonary hypertension (corpulmonale)
  • Pulmonary embolism
  • Chronic lung disease e.g. interstitial lung disease, cystic fibrosis

Valvular

  • Tricuspid regurgitation
  • Pulmonary valve disease

LHF -> CHF

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7
Q

which conditions require a higher cardiac ouput and therefore put strain on the heart?

A

NAP MEALS

  • Nutritional (B1/thiamine deficiency)
  • Anaemia
  • Pregnancy
  • Malignancy
  • Endocrine
  • AV malformations
  • Liver cirrhosis
  • Sepsis
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8
Q

what happens if fluid is congested backwards in LHF and RHF?

A

LHF: fluid accumulates in lungs -> respiratory symptoms

RHF: fluid accumulates in the peripheries -> swelling signs

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9
Q

what are the symptoms of LHF?

A

Respiratory Problems

Dyspnoea:

  • Paroxysmal nocturnal dyspnoea (PND)
  • Exertional dyspnoea
  • Orthopnoea

Nocturnal cough (+/- pink frothy sputum)

Fatigue

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10
Q

What are the signs of left heart failure?

A
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11
Q

what are the symptoms of RHF?

A
  • Fatigue
  • Reduced exercise tolerance
  • Anorexia
  • Nausea
  • Nocturia
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12
Q

what are the signs of RHF?

A
  • Face: face swelling
  • Neck: ↑ JVP
  • Heart/Chest: TR murmur, ↑ HR, ↑ RR
  • Abdomen: ascites, hepatomegaly
  • Other: ankle and sacral pitting oedema
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13
Q

JB is a 34-year-old male, with a history of infective endocarditis, complaining that he’s tiredall the time and struggles to run as far as he used to. He also says that his anklesand facefeel more swollenthan before.

On examination, he has a raised JVP, breathing rate and heart rate. You also hear a pansystolic murmuron auscultation.

What is the most likely diagnosis?

A. Left heart failure secondary to mitral regurgitation

B. Left heart failure secondary to cocaine abuse

C. Right heart failure secondary to tricuspid regurgitation

D. Myocardial infarction

E. High output heart failure

A

C. Right heart failure secondary to tricuspid regurgitation

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14
Q

what are the investigations for cardiac failure?

A

Bedside: ECG

Bloods: FBC, U&Es, LFTs, TFTs, BNP

Imaging: CXR, TTE

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15
Q

which investigation is diagnostic for HF?

A

Transthoracic echocardiogram (TTE) coupled with doppler = DIAGNOSTIC

  • Visualise the structure and function of the heart -> may show the cause of HF
  • Can calculate ejection fraction (EF): % of the blood present in the LV that gets pumped during systole – normal = 50-70%
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16
Q

outline the classification of heart failure in terms of ejection fraction?

A

EF < 40%: HF with reduced ejection fraction (HFrEF) – previously called systolicHF

  • Indicates inability of the ventricle to contract normally

EF >50%: HF with preserved ejection fraction (HFpEF) – previously called diastolicHF

  • Indicates inability of the ventricle to relax and fill normally
17
Q

what is seen on the x ray for heart failure?

A

Alveolar oedema

B-lines (Kerley)

Cardiomegaly

Dilated upper lobe vessels + Diverted upper lobe

Effusion (Transudative pleural effusion)

18
Q

which criteria is used to diagnose heart failure?

A

Framingham Criteria

2+ majors OR 1 major and 2 minors

19
Q

outline the management of cardiac failure?

A

ACE inhibitors: give to all patients with LV dysfunction

  • Enalapril, perindopril, ramipril (all end in –pril)
  • Can switch to ARB if not tolerable (cough)

Beta-blockers: reduce O2demand on the heart

  • Bisoprolol, carvedilol

Diuretics: use if evidence of fluid retention

  • Loop diuretics e.g. furosemide
  • Aldosterone antagonists e.g. spironolactone

Hydralazine + nitrates – considered in Afro-Caribbean patients

Digoxin– positive inotrope, improves symptoms but not mortality

Cardiac resynchronization therapy – aims to improve timings of contraction of atria and ventricles

20
Q

outline the management for acute heart failure?

A
21
Q

what are the complications of heart failure?

A
  • Respiratory failure
  • Renal failure - due to hypoperfusion
  • Acute exacerbations
  • Death
22
Q

outline the prognosis of heart failure?

A
  • Very poor, worse than most malignancies
  • 50% of severe HF patients die within 2 years
  • Acute HF in-hospital mortality = 2-20%
23
Q

what drugs should be avoided in cardiac failure?

A

srugs that adversel affect the heart due to systlic dysfunciton- NSAIDs, non- dihydropyridine CCBs

Cardiology (35 decks)

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