Cardio - Heart Failure Flashcards
what is HF?
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.
what is ejection fraction? how is this calculated?
EF = % of blood in ventricle which is pumped out with each heart beat (normally >60%)
EF = ((EDV - ESV) / EDV) x 100
what is the difference between HFrEF and HFpEF?
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.
name the 2 most common causes of HF in UK. name some other causes.
Most common: coronary heart disease and HTN.
- 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) - Valvular heart disease:
- aortic stenosis (chronic excessive afterload causes LV hypertrophy)
- aortic regurgitation, mitral regurgitation, tricuspid regurgitation, ASD, VSD
3.Tachy- and brady-arrythmias
- Increased peripheral demand (when CO is normal increased/high-output HF):
- anaemia
- pregnancy
- sepsis
- hyperthyroidism
what are the common causes of RHF?
- 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)
describe the signs and symptoms that may be present in LHF
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
describe the signs and symptoms that may be present in RHF
Symptoms:
- fatigue
- anorexia and GI distress
- peripheral pitting oedema (legs, sacrum)
Signs:
- raised JVP
- hepatosplenomegaly
- ascites
- liver failure
which investigations would you request for a pt with suspected heart failure?
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
describe the typical features of HF on CXR
- Alveolar shadowing (‘bat wing’ sign) - due to pulmonary oedema
- Kerley B lines - due to intersitial oedema causing thickening of subpleural interlobular septa
- Cardiomegaly
- Diversion of pulmonary vessels - blood to upper lobes
- Pleural effusion - due to pulmonary oedema
what lifestyle changes would you suggest to a pt with HF?
- smoking cessation
- weight management
- sensible fluid restriction in severe HF (avoiding dehydration), monitoring fluid retention by regular weightings (seek advice if unexpected 2kg+ gain in 3 days)
- limit alcohol intake to recommended safe limits
- aerobic exercise, esp. as part of supervised cardiac rehabilitation programme
which medications would you advise for a pt with HF
Symptom management
- loop diuretics - FUROSEMIDE (symptomatic relief of fluid overload)
- +/- DIGOXIN
Disease treatment
- ACEi/ARB (all pts) - e.g. LISINOPRIL, LOSARTAN
- B-blocker (all pts) - e.g. CARVEDILOL, BISOPROLOL
- SPIRONOLACTONE (moderate-severe HF) (improves mortality via inhibition of cardiac fibrosis effects of aldosterone)
