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Medical Finals (High Yield) > [Cardio] Chronic Heart Failure > Flashcards

[Cardio] Chronic Heart Failure Flashcards

1
Q

what are the signs and sx of CHF?

A
  • SOB
  • reduced exercise tolerance
  • orthopnoea and PND
  • peripheral oedema
  • raised JVP
  • lung base crackles
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2
Q

what does heart failure with reduced ejection fraction (HFrEF) mean?

A

LVEF <40% on ECHO

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3
Q

what does heart failure with preserved ejection fraction (HFpEF) mean?

A

LVEF >50% on ECHO

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4
Q

what do you do once you suspect heart failure based on clinical signs and sx?

A

bloods, CXR, ECG

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5
Q

what marker would you specifically measure?

A

BNP

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6
Q

what does a BNP <400ng/L tell you?

A

unlikely heart failure

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7
Q

what does a BNP 400-2000ng/L prompt you to do?

A

referral for ECHO + specialist review <6 weeks

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8
Q

what does a BNP >2000ng/L prompt you to do?

A

referral for ECHO + specialist review <2 weeks

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9
Q

how do you manage HFrEF?

A

1st line: beta blockers e.g. Bisoprolol + ACEi e.g. Ramipril / ARB e.g. Losartan

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10
Q

what will you do if pt is still symptomatic and LVEF <35% after 1st line mx of HFrEF?

A

2nd line: mineralocorticoid antagonist e.g. Spironolactone

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11
Q

what will you do if pt is still symptomatic and LVEF <35% after 2nd line mx of HFrEF?

A

3rd line options:

  • Sacubitril / Valsartan (Entresto)
  • Ivabradine
  • cardiac resynchronisation therapy

should be initiated by a specialist

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12
Q

how do you manage HFpEF?

A

loop diuretics e.g. Furosemide to give symptomatic relief from volume overload

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13
Q

what is the feature of class I NYHA functional classification of heart failure?

A

not limited by sx

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14
Q

what is the feature of class II NYHA functional classification of heart failure?

A

sx on usual physical exertion

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15
Q

what is the feature of class III NYHA functional classification of heart failure?

A

sx on less than usual physical exertion

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16
Q

what is the feature of class IV NYHA functional classification of heart failure?

A

sx at rest

17
Q

which drugs have been shown to improve mortality?

A

BB and ACEi

furosemide is for symptomatic benefit only

18
Q

why should you never use ACEi and Entresto together?

A

risk of angio-oedema

19
Q

what is Bumetanide?

A

loop diuretic, better bioavailability than furosemide

20
Q

1st line medication for all HFrEF pts is an ACEi and cardioselective BB. Is COPD a contraindication to BB use?

21
Q

what should pts have checked 2 weeks after starting / increased dose of ACEi or Spironolactone?

A

renal function

Medical Finals (High Yield) (57 decks)

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