Cardiology Flashcards
First line therapy for heart failure (with reduced LVEF)
ACE inhibitor + beta-blocker
Start one drug at a time
Second-line therapy for heart failure
Aldosterone antagonists e.g. spironolactone + eplerenone
Initiated if symptoms not controlled with ACEi and beta-blocker
Ejection fraction considered to be heart failure with reduced ejection fraction
<50%
What causes heart failure with preserved ejection fraction
Diastolic dysfunction - impaired left ventricular filling during diastole
NYHA Class I for heart failure
No limitation on activity
NYHA Class II for heart failure
Comfortable at rest but symptomatic with ordinary activities
NYHA Class III for heart failure
Comfortable at rest but symptomatic with any activity
NYHA Class IV for heart failure
Symptomatic at rest
Referral criteria for NT-proBNP result
400-2000 –> seen and have echo within 6 weeks
>2000 –> within 2 weeks
In which patients are ACE inhibitors avoided in heart failure
Patients with valvular heart disease until initiated by a specialist
What blood test is especially important to monitor in people with HF?
U+Es esp. potassium as both ACEi and aldosterone antagonists increase potassium
Class of diabetes medication useful in heart failure
SGLT2 inhibitors e.g. dapaglifozin
Soft 1st heart sound
Long PR interval
Mitral regurgitation
Loud 1st heart sound
Mitral stenosis
Soft 2nd heart sound
Aortic stenosis
What causes 3rd heart sound
Diastolic filling of the ventricle
Split 2nd heart sound
Normal if during inspiration
When is 3rd heart sound normal
If <30 years old
May persist in women up to 50 years old
Abnormalities associated with 3rd heart sound
Left ventricular failure e.g. dilated cardiomyopathy
Constrictive pericarditis
Mitral regurgitation
What causes 4th heart sound
Atrial contraction against a stiff ventricle - coincides with P wave on ECG
Abnormalities associated with 4th heart sound
Aortic stenosis
Hypertrophic obstructive cardiomyopathy - may also have a double apical impulse
Hypertension
