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
When is hydralazine and nitrate preferred
Second line if afro-carribean descent
OR
First line if intolerant of ACEi/ARB
