Cardio - Heart Failure Flashcards

1
Q

what is HF?

A

Clinical syndrome involving a decreased CO and/or increased intracardiac pressure at rest or during stress, resulting in failure to maintain an adequate circulation for needs of body.

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2
Q

what is ejection fraction? how is this calculated?

A

EF = % of blood in ventricle which is pumped out with each heart beat (normally >60%)

EF = ((EDV - ESV) / EDV) x 100

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3
Q

what is the difference between HFrEF and HFpEF?

A

HFrEF = decreased strength of ventricular contraction causing EF <40% and thus decreased CO.

HFpEF = impaired ventricular filling causing decreased preload and thus decreased SV (but normal EF) and decreased CO.

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4
Q

name the 2 most common causes of HF in UK. name some other causes.

A

Most common: coronary heart disease and HTN.

  1. Myocardial disease:
    - cardiomyopathies
    - drugs (B-blockers, CCBs, anti-arrhythmics…)
    - toxins (alcohol, cocaine…)
    - endocrine (diabetes, hypo-/hyperthyroidism, Cushing’s syndrome, adrenal insufficiency, phaeochromocytoma)
    - infiltrative (sarcoidosis, amyloidosis, haemochromatosis, CT disease)
  2. Valvular heart disease:
    - aortic stenosis (chronic excessive afterload causes LV hypertrophy)
    - aortic regurgitation, mitral regurgitation, tricuspid regurgitation, ASD, VSD

3.Tachy- and brady-arrythmias

  1. Increased peripheral demand (when CO is normal increased/high-output HF):
    - anaemia
    - pregnancy
    - sepsis
    - hyperthyroidism
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5
Q

what are the common causes of RHF?

A
  • LHF most commonly (decreased CO increases pressure in pulmonary vasculature and thus in RH)
  • chronic lung disease (cor pulmonale)
  • PE
  • L to R shunt
  • valvular disease (pulmonary valve stenosis or tricuspid valve regurgitation)
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6
Q

describe the signs and symptoms that may be present in LHF

A

Symptoms:

  • dyspnoea, orthopnoea, PND
  • fatigue, reduced exercise tolerance
  • dizziness, syncope
  • cough +/- blood-tinged sputum

Signs:

  • bilateral basal end-inspiratory crackles (rales) +/- wheeze
  • tachycardia, arrhythmias
  • inferolaterally displaced apex beat (LV dilation or hypertrophy)
  • 3rd heart sound (gallop rhythm)
  • cyanosis
  • anaemia
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7
Q

describe the signs and symptoms that may be present in RHF

A

Symptoms:

  • fatigue
  • anorexia and GI distress
  • peripheral pitting oedema (legs, sacrum)

Signs:

  • raised JVP
  • hepatosplenomegaly
  • ascites
  • liver failure
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8
Q

which investigations would you request for a pt with suspected heart failure?

A

Bloods:

  • NT-proBNP: likely HF if >400 ng/L (refer urgently for specialist assessment if >2000 ng/L)
  • FBC: ?anaemia
  • UandEs: urea and creatinine usually raised
  • eGFR: HTN can cause renal failure
  • LFTs
  • HbA1c
  • TFTs
  • troponin I and T: ?recent undiagnosed MI

Bedside tests:

  • ECG: ID potential aetiological factors and required for Tx decisions
  • urinalysis: proteinuria if renal failure

Imaging:

  • TTE: assess ventricular function and associated pathology (e.g. valves)
  • CXR: supportive evidence for HF and exclude other causes for SOB
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9
Q

describe the typical features of HF on CXR

A
  1. Alveolar shadowing (‘bat wing’ sign) - due to pulmonary oedema
  2. Kerley B lines - due to intersitial oedema causing thickening of subpleural interlobular septa
  3. Cardiomegaly
  4. Diversion of pulmonary vessels - blood to upper lobes
  5. Pleural effusion - due to pulmonary oedema
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10
Q

what lifestyle changes would you suggest to a pt with HF?

A
  1. smoking cessation
  2. weight management
  3. sensible fluid restriction in severe HF (avoiding dehydration), monitoring fluid retention by regular weightings (seek advice if unexpected 2kg+ gain in 3 days)
  4. limit alcohol intake to recommended safe limits
  5. aerobic exercise, esp. as part of supervised cardiac rehabilitation programme
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11
Q

which medications would you advise for a pt with HF

A

Symptom management

  1. loop diuretics - FUROSEMIDE (symptomatic relief of fluid overload)
  2. +/- DIGOXIN

Disease treatment

  1. ACEi/ARB (all pts) - e.g. LISINOPRIL, LOSARTAN
  2. B-blocker (all pts) - e.g. CARVEDILOL, BISOPROLOL
  3. SPIRONOLACTONE (moderate-severe HF) (improves mortality via inhibition of cardiac fibrosis effects of aldosterone)
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