Cardiovascular Flashcards
What does HFpEF stand for?
Heart failure with preserved left ventricular ejection fraction
What was heart failure with preserved left ventricular ejection fraction (HFpEF) previously known as?
Diastolic heart failure
What is HFpEF classified as?
Heart failure with a left ventricular ejection fraction of greater than 40%.
Describe the prevalence of HFpEF
HFpEF is more common in certain population groups, including older women and patients with elevated blood pressure.
What is 1 principle of treatment for a patient with HFpEF?
- Diagnose and treat the cause (eg hypertension)
What are 2 principles of treatment for a patient with HFpEF?
- Diagnose and treat the cause (eg hypertension)
- Identify and treat precipitating factors (eg arrhythmias such as atrial fibrillation)
What are 3 principles of treatment for a patient with HFpEF?
- Diagnose and treat the cause (eg hypertension)
- Identify and treat precipitating factors (eg arrhythmias such as atrial fibrillation)
- Treat the symptoms (eg diuretics to treat congestion)
What are 4 principles of treatment for a patient with HFpEF?
- Diagnose and treat the cause (eg hypertension)
- Identify and treat exacerbating conditions (eg atrial fibrillation)
- Treat the symptoms (eg diuretics to treat congestion)
- Recognise and treat comorbidities (eg hypertension, ischaemic heart disease, diabetes).
Describe the evidence for drug therapy in HFpEF.
The drugs that have proven outcome benefits in heart failure with reduced ejection fraction (HFrEF) have not been studied for outcomes in HFpEF. However, the drugs used to treat HFrEF are often used to treat HFpEF.
Describe the role of ACE inhibitor therapy in HFpEF.
While patients with HFpEF may benefit from angiotensin converting enzyme inhibitor (ACEI) therapy (which is often indicated for a comorbidity), there is insufficient evidence to recommend routine ACEI therapy in patients with HFpEF.
Describe the role of beta-blocker therapy in HFpEF.
Beta-blocker therapy may also be beneficial in patients with HFpEF, particularly in patients with atrial fibrillation with a fast resting ventricular rate, or with coexisting ischaemic heart disease.
Name 1 class of drug which can cause harm in patients with HFpEF
- Diuretics
Name 2 classes of drugs which can cause harm in patients with HFpEF
- Diuretics
- Venodilators
Name 3 classes of drugs which can cause harm in patients with HFpEF
- Diuretics
- Venodilators
- Powerful arterial vasodilators
Name 4 classes of drugs which can cause harm in patients with HFpEF
- Diuretics
- Venodilators
- Powerful arterial vasodilators
- Digoxin and other inotropic drugs
Why are diuretics potentially harmful for patients with HFpEF?
Patients with HFpEF generally have normal left ventricular volume and are sensitive to diuretics. Excessive diuresis can lead to a severe reduction in cardiac output and blood pressure
Name an example of a venodilator
Isosorbide dinitrate
Why are venodilators (such as isosorbide dinitrate) potentially harmful in HFpEF?
They can cause a severe reduction in cardiac output and blood pressure.
Name an example of a powerful arterial vasodilator
Hydralazine
Why are powerful arterial vasodilators (such as hydralazine) potentially harmful in HFpEF?
They can cause dynamic left ventricular outflow obstruction
Describe the role of digoxin and other inotropic drugs in HFpEF
They should be avoided unless the patient is in atrial fibrillation.
Which SGLT2 inhibitor has more evidence for HFpEF?
Empagliflozin
What is are 3 good signs a patient can use to determine they may be accumulating fluid?
- Orthopnoea
- Loss of appetite
- Peripheral oedema
What should you always remember about cardioversion in heart failure patients?
We try to get patients as dry and as stable as possible before cardioversion as this makes it most likely they will maintain normal rhythm post cardioversion.
