[Cardio] Chronic Heart Failure Flashcards
what are the signs and sx of CHF?
- SOB
- reduced exercise tolerance
- orthopnoea and PND
- peripheral oedema
- raised JVP
- lung base crackles
what does heart failure with reduced ejection fraction (HFrEF) mean?
LVEF <40% on ECHO
what does heart failure with preserved ejection fraction (HFpEF) mean?
LVEF >50% on ECHO
what do you do once you suspect heart failure based on clinical signs and sx?
bloods, CXR, ECG
what marker would you specifically measure?
BNP
what does a BNP <400ng/L tell you?
unlikely heart failure
what does a BNP 400-2000ng/L prompt you to do?
referral for ECHO + specialist review <6 weeks
what does a BNP >2000ng/L prompt you to do?
referral for ECHO + specialist review <2 weeks
how do you manage HFrEF?
1st line: beta blockers e.g. Bisoprolol + ACEi e.g. Ramipril / ARB e.g. Losartan
what will you do if pt is still symptomatic and LVEF <35% after 1st line mx of HFrEF?
2nd line: mineralocorticoid antagonist e.g. Spironolactone
what will you do if pt is still symptomatic and LVEF <35% after 2nd line mx of HFrEF?
3rd line options:
- Sacubitril / Valsartan (Entresto)
- Ivabradine
- cardiac resynchronisation therapy
should be initiated by a specialist
how do you manage HFpEF?
loop diuretics e.g. Furosemide to give symptomatic relief from volume overload
what is the feature of class I NYHA functional classification of heart failure?
not limited by sx
what is the feature of class II NYHA functional classification of heart failure?
sx on usual physical exertion
what is the feature of class III NYHA functional classification of heart failure?
sx on less than usual physical exertion
