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Year 3 > Cardiac failure (CV) > Flashcards

Cardiac failure (CV) Flashcards

1
Q

Define cardiac failure.

A

Inability of the cardiac output to meet the body’s demands, despite normal venous pressures

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2
Q

Which age group is cardiac failure most common in?

A

> 65 years old

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3
Q

What are the three types of cardiac failure?

A
  • left heart failure (systolic + diastolic)
  • right heart failure
  • congestive heart failure - left HF + right HF
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4
Q

What are the two types of left heart failure?

A
  • systolic heart failure
  • diastolic heart failure
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5
Q

Define systolic heart failure.

A

HFrEF <40%, unable to pump blood

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6
Q

What are some causes of systolic heart failure? (4)

A

DAMI:

  • dilated cardiomyopathy
  • arrhythmias
  • myocarditis
  • ischaemic heart disease
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7
Q

What heart sound is heard in systolic heart failure?

A
  • S3
  • rapid filling of ventricles at start of diastole - normal variant in young and athletes due to strong atrial contraction
  • abnormal in left-sided HF usually due to mitral regurgitation –> over-filled LA = when mitral valve opens in diastole a lot of blood rapidly empties into ventricle - sign of systolic HF, usually with MR
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8
Q

Define diastolic heart failure.

A

HFpEF >50%, heart cannot relax and properly fill with blood

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9
Q

What are some causes of diastolic heart failure? (4)

A
  • hypertrophic obstructive cardiomyopathy
  • restrictive cardiomyopathy
  • constrictive pericarditis
  • cardiac tamponade
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10
Q

What heart sound is heard in diastolic heart failure?

A
  • S4
  • atrial-kick near the end of diastole as the atria contract hard trying to force blood into a ‘stiff non-compliant ventricle’ - classically associated with diastolic HF
  • pure diastolic HF is are, whereas pure systolic and mixed HF are more common = S3 much more common in HF
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11
Q

What are some causes of right heart failure? (4)

A

LIPT(on iced tea will give you heart failure):

  • secondary to Left HF (congestive HF)
  • Infarction
  • Pulmonary hypertension
  • Tricuspid regurgitation
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12
Q

How can you categorise cardiac failure? (4)

A
  • acute
  • chronic
  • low output state - low cardiac output
  • high output state - NORMAL heart unable to pump enough blood to meet metabolic needs of the body
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13
Q

What conditions can cause a high output state - cardiac failure? (4)

A
  • anaemia
  • Beri-Beri –> thiamine deficiency
  • pregnancy
  • hyperthyroidism
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14
Q

What are the clinical features of high output state cardiac failure? (3)

A

Heart failure with fluid overload:

  • acute breathlessness with no associated pain
  • bilateral pitting oedema
  • elevated JVP
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15
Q

What are the clinical features of left heart failure? (6)

A
  • dyspnoea
  • orthopnoea
  • paroxysmal nocturnal dyspnoea
  • bibasal crackles on inspiration
  • pink frothy sputum - due to pulmonary oedema
  • wheeze
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16
Q

When are inspiratory vs expiratory bibasal crackles heard?

A
  • inspiratory - left HF
  • expiratory - lung fibrosis
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17
Q

What is an early sign of LV failure?

A

S3 gallop rhythm

18
Q

Why do patients get pulmonary symptoms in left heart failure?

A

Fluid accumulation in lungs –> pulmonary oedema

19
Q

What are the clinical features of right heart failure? (4)

A
  • swollen ankles - peripheral oedema
  • raised JVP
  • hepatomegaly - pulsatile liver edge on palpation
  • ascites
20
Q

Why do patients get swollen signs in right heart failure?

A

Fluid accumulates in peripheries as it is congested backwords (into systemics)

21
Q

Why do you get different types of symptoms in left vs right heart failure?

A
  • left HF - fluid build up in lungs as left heart not functioning properly
  • right HF - fluid build up in peripheries as right heart not working properly
22
Q

What is the first-line investigation for heart failure?

A

BNP - raised in heart failure - sensitive but not specific

23
Q

What drug types can cause a falsely low BNP? (5)

A
  • ACEi
  • ARBs
  • beta blockers
  • diuretics
  • aldosterone antagonists
24
Q

What investigation is diagnostic for heart failure?

A

Transthoracic echocardiogram - done if BNP is raised for confirmation of heart failure

25
Q

What can you calculate from transthoracic echocardiogram in heart failure?

A
  • ejection fraction
  • EF<40% = HFrEF –> systolic dysfunction
  • EF>50% = HFpEF –> diastolic dysfunction
26
Q

What would you see on CXR in heart failure? (5)

A

ABCDE

  • Alveolar shadowing (oedema)
  • Kerley-B lines (horizontal lines in lung periphery that extend to pleural surface; thickened, oedematous interlobular septa due to pulmonary oedema)
  • Cardiomegaly
  • Dilated upper lobe vessels due to diversion of blood to upper lobe
  • pleural Effusion - notching of costophrenic angles, meniscus sign
27
Q

What are Kerley-B lines seen on CXR in heart failure?

A
  • horizontal lines in lung periphery that extend to pleural surface
  • thickened, oedematous interlobular septa due to pulmonary oedema
28
Q

What other investigations are done in heart failure? (3)

A
  • ECG
  • ABG
  • bloods -
    • rule out anaemia
    • look for hyperthyroidism - may led to high-output HF and cause hypervolaemic hyponatraemia, managed by fluid restriction
29
Q

How is clinical diagnosis of heart failure made?

A

Framingham criteria: 2+ majors, or 1 major + 2 minors:
Major:
- paroxysmal nocturnal dyspnoea
- bibasal crepitations
- S3 gallop
- cardiomegaly
- increased central venous pressure
- weight loss
- neck vein distension
- acute pulmonary oedema
- hepatojugular reflex
Minor:
- bilateral ankle oedema
- dyspnoea on exertion
- tachycardia
- decrease in vital capacity by 1/3
- nocturnal cough
- hepatomegaly
- pleural effusion

30
Q

What is the management plan for acute heart failure? (4)

A

Treat pulmonary oedema - SOMF:

  • Sit patient up
  • Oxygen
  • Morphine
  • IV Furosemide (loop diuretic - inhibits Na/K/Cl cotransporter in thick ascending LoH, can cause hypokalaemia)
31
Q

What electrolyte imbalance can furosemide (loop diuretic used in HF) cause?

A

Hypokalaemia

32
Q

How do we manage acute HF if the patient is in cardiogenic shock e.g. hypotension <85mmHg?

A

Give inotropes - dobutamine

33
Q

How do you manage acute right heart failure?

A

May do fluid challenge

34
Q

What do you do if acute heart failure is not responding to treatment?

A

Consider CPAP

35
Q

What is the management plan for chronic heart failure (HFrEF)?

A
  • 1st line: ACEi (ramipril) + beta blocker (bisoprolol)
  • 2nd line: aldosterone antagonist (spironolactone) - given alongside 1st-line Rx in those with HFrEF if they continue to have symptoms
    • if there are troublesome side effects of spironolactone e.g. gynaecomastia, give eplerenone
  • can give SGLT-2 inhibitors alongside this
36
Q

What medication is contraindicated in heart failure?

A

Rate-limiting CCBs e.g. verapamil or diltiazem

37
Q

What broad pharmacological interventions are advised for heart failure? (2)

A
  • annual influenza vaccine
  • one-off pneumococcal vaccine
38
Q

What conservative management is there for heart failure? (3)

A
  • daily weights
  • fluid restriction
  • catheter/fluid balance
39
Q

Describe the prognosis of heart failure.

A

50% with heart failure die within 2 years

40
Q

What is the NYHA classification of cardiac failure?

A
  • stage I - no limitation on ordinary physical activity
  • stage II - normal at rest, ordinary physical activity causes breathlessness
  • stage III - normal at rest, less than ordinary physical activity causes breathlessness
  • stage IV - symptoms at rest

Year 3 (95 decks)

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