Cardiology: Chronic HF Flashcards
NYHA Class I
no symptoms
no limitation
NYHA Class II
mild symptoms
slight limitation of physical activity: comfortable at rest but ordinary activity results in fatigue, palpitations or dyspnoea
NYHA Class III
moderate symptoms
marked limitation of physical activity: comfortable at rest but less than ordinary activity results in symptoms
NYHA Class IIII
severe symptoms
unable to carry out any physical activity without discomfort: symptoms of heart failure are present even at rest with increased discomfort with any physical activity
What classes as high, raised or low BNP/ntproBNP levels?
High: >400 (ntpro >2000)
Raised: 100-400 (400-2000)
Low: <100 (<400)
How to manage high/raised bnp levels?
High: specialist assessment (including transthoracic echocardiography) within 2 weeks
Raised: specialist assessment (including transthoracic echocardiography) within 6 weeks
First line treatment for HF
ACE-inhibitor and a beta-blocker
one drug should be started at a time
consider ARB if intolerant of ACEi
Beta blockers liscenced in HF
bisoprolol, carvedilol, and nebivolol
What to consider adding if ACEi/BB not helping
Aldosterone antagonist
Second line treatment for HF
cardiac resynchronisation therapy digoxin
ivabradine
sucubtril-valsartan
hydralazine + nitrate
Indications for ivabradine
- Patient is already on suitable therapy (ACE-inhibitor, beta-blocker + aldosterone antagonist),
- HR> 75/min
- Left ventricular fraction < 35%
Additional medications used in HF
diuretics - overload
annual influenza vaccine
one-off pneumococcal vaccine
When is sacubitril-valsartan considered?
Heart failure with EF <35% who are symptomatic on ACE inhibitors or ARBs
Should be initiated following ACEi or ARB wash-out period
When is digoxin considered
Heart failure in sinus rhythm
When is cardiac resynchronisation therapy preferred?
Patients with heart failure and wide QRS
