Cardiology-HF Flashcards
What is the universal definition of heart failure?
A clinical syndrome with symptoms/signs due to a structural or functional cardiac abnormality, confirmed by LVEF <50% or elevated natriuretic peptides.
What are the four classifications of heart failure based on LVEF?
HFrEF (≤40%) → Heart Failure with Reduced Ejection Fraction
HFmrEF (41-49%) → Heart Failure with Mildly Reduced EF
HFpEF (≥50%) → Heart Failure with Preserved EF
HFimpEF → LVEF improved from ≤40% by ≥10 points to >40%
Most important compensatory mechanism is
activation of neurohormonal systems. Name 4 mechanisms:
– Sympathetic nervous system
– Renin-angiotensin-aldosterone system
– Non-osmotic release of arginine vasopressin
– Natriuretic peptides
What is the role of natriuretic peptides in heart failure?
They promote natriuresis, vasodilation, and renin suppression, counteracting the SNS and RAAS.
What are the key symptoms of congestion in heart failure?
Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, ankle swelling, pulmonary crackles.
What biomarker levels indicate acute heart failure?
BNP >100 pg/mL, >400pg/mL very likely
NT-proBNP >300pg/mL, >450pg/mL very likely
What are the four main clinical presentations of acute heart failure?
Acute decompensated HF, acute pulmonary edema, cardiogenic shock, isolated right ventricular failure
What is the initial approach to managing acute heart failure?
Lasix (diuretics), Morphine, Nitrates, Oxygen, Position (seated upright)
What is the first-line diuretic for acute decompensated heart failure?
IV furosemide (loop diuretics).
When are inotropes indicated in AHF?
For cardiogenic shock or persistent hypoperfusion despite diuretics and vasodilators.
What are the contraindications for IABP (intra-aortic balloon pump)?
Aortic regurgitation, aortic dissection, severe PAD.
What are the common causes of acute heart failure?
(CHAMPIT)
acute Coronary syndrome
Hypertension emergency
Arrhythmia
Mechanical cause
Pulmonary embolism
Infection
Tamponade
What is the most useful imaging modality for diagnosing heart failure?
Echocardiography – it assesses LVEF, valvular disease, and wall motion abnormalities.
What are typical chest X-ray findings in acute heart failure?
Cardiomegaly, pulmonary edema, Kerley B lines, pleural effusion, pulmonary congestion.
What is the Forrester classification of acute heart failure?
Categorizes patients based on cardiac output (CI) and pulmonary capillary wedge pressure (PCWP):
Warm & Dry (I): Normal perfusion, no congestion
Warm & Wet (II): Normal perfusion, congested (most common)
Cold & Dry (III): Hypoperfusion, no congestion
Cold & Wet (IV): Hypoperfusion and congestion (worst prognosis)
What are the four pillars of guideline-directed medical therapy (GDMT) in HFrEF?
ARNI/ACEi/ARB (Sacubitril/Valsartan or Lisinopril)
Beta-blockers (Carvedilol, Metoprolol, Bisoprolol)
MRAs (Spironolactone)
SGLT2 inhibitors (Dapagliflozin, Empagliflozin)
What device therapy is recommended for HFrEF patients with LVEF ≤35%?
ICD (Implantable Cardioverter Defibrillator) for primary prevention of sudden cardiac death.
Treatment goals in acute HF
Clinical
- reduce symptoms, clinical signs, congestion
- increase diuresis, oxygenation
Laboratory
- Normalise pH, serium electrolyte, BGM
- Reduce urea and/or creatinine, serum bilirubin
Hemodynamic
- Reduce PCWP <18mmHg
- Increase CO and tissue perfusion
What are the recommended tests for chronic heart failure?
BNP/Pro-BNP, 12 lead ECG, TTE, CXR, labs: FBC, urea, electrolyte, thyroid, fasting glucose, HbA1C, lipids, Iron status
What are the recommended tests to monitor for progress in acute heart failure?
– Urea, creatinine, electrolytes
– NT-proBNP
– Arterial blood gases
– Serum lactate level
– Haemoglobin
– Chest Xray
– Others as indicated
Tests to evaluate aetiology of heart failure
– Echocardiogram
– Coronary angiography (invasive or CT coronary
angiogram)
– Cardiac stress testing– Cardiac MRI
– Endomyocardial biopsy
Tests to evaluate pulmonary congestion,
structural heart disease & cardiac dysfunction
– ECG (rhythm, structural abnormalities)
– BNP/NT-proBNP levels
– Cardiac troponins
– Echocardiogram
– Cardiac MRI
– Chest Xray (pulmonary congestion, exclude other
pulmonary pathology)
– Lung ultrasound (presence of 3 or more B-lines per
intercostal space a sign of lung interstitial syndrome
Tests to evaluate the acutely ill patient:
– Full blood counts (anaemia, leucocytosis)
– Urea, creatinine, electrolytes (renal impairment,
hypokalaemia)
– Arterial blood gases (acidosis, hypoxemia, hypercarbia)
– Serum lactate
– Liver function tests (transaminitis, hypoalbuminemia)
– Thyroid function tests
– Iron studies
– Pancultures if high clinical suspicion of infection
What is the definition of chronic heart failure (CHF)?
A clinical syndrome characterized by impaired cardiac function leading to symptoms such as dyspnea, fatigue, and fluid retention
