Cardiology- Heart failure Flashcards
What are the 8 known causes of heart failure?
- Ischaemic heart disease
- Hypertension
- Valvular heart disease
- Atrial fibrillation
- Chronic lung disease
- Cardiomyopathy
- Previous cancer chemo drugs
- HIV
What is HFREF?
Heart failure reduced ejection fraction.
Systolic heart failure, around 50% of cases
What is HFNEF?
Heart failure normal ejection fraction.
ECGs show mild impairment or normal systolic function
What factors contribute to a patient having HFNEF?
Elderly
Overweight
Hypertension
Atrial Fibrillation
What is the physiology behind HFNEF?
Impaired filling or diastolyic dysfunction
What is the mortality rate after heart failure diagnosis?
10% as inpatient
50% in the following 12 months after discharge
What 6 factors worsen the prognosis after heart failure?
Fluid overload High NT-proBNP levels Renal impairment Advanced age Multi-morbidity Frequent heart failure admissions
What 6 things can be tested in bloods for heart failure investigation?
- Renal function
- FBC
- LFTs hepatic congestion
- TFTs thyroid disease
- Ferritin and transferrin
- Brain natriuretic peptid (NT-proBNP)
Why doesn’t elevated NTproBNP definitely mean heart failure?
Any event which causes increased cardiac stress can elevate this peptide.
eg. atrial fibrillation or RV strain
How is LV function assessed?
ECG
Cardiac MRI
What 4 lifestyle modifications are put in place to reduce risk of heart failure?
- Smoking cessation
- Restriction of alcohol consumption
- Salt restriction
- Fluid restriction
What is the most effective symptomatic treatment for heart failure?
Loop diuretics -Furosemide -Bumetanide -Bendroflumethiazide =Metolozone
What treatment is especially useful for a patient who is hypertensive?
Angiotensin converting enzyme inhibitors (ACEIS)
What are valsartan and candesartan examples of?
Angiotensin 2 receptor antagonists
What are angiotensin receptor-neprilysin inhibitors recommended for?
Treatment of chronic heart failure with reduced ejection fraction Only for people with NYHA class II to IV symptoms with LV ejection fraction less than 35% Already on a stable dose of ACEIs or ARBs
Give 3 examples of beta-blockers
6-blockers
Carvedilol
Bisoprolol
What factors determine if it is safe to initiate usage of 6-blockers?
Systolic BP >100mmHg
Resting heart rate >60bpm
No significant postural drop
What drugs are generally used if people cannot take ACEI or ARBs?
Vasodilators such as hydralazine and isosobide mononitrate
What drug is used for those who cannot tolerate 6-blockers?
Ivabradine
Why is ivabradine useful for those with low BP?
Has no effect on blood pressure
What 3 things do nitrates reduce?
Preload
Pulmonary oedema
Ventricular size
What can nitrates relieve in chronic heart failure?
Orthopnoea and exertional dyspnoea
What is evident on ECGs to warrant fitting of a pacemaker?
Left bundle branch block
-QRS duration is broad. Depolarisation of electricity from septum to lateral wall is delayed leading to mechanical reduction
What type of pacemaker is fit to reduce the duration of the QRS phase?
Cardiac resynchronisation pacemaker (CRT_
