CCC - HF Flashcards
What is heart failure?
Inadequate cardiac output for body’s requirements
How common is heart failure >85yrs old?
20%
What LV systolic dysfunction?
Reduced cardiac output to systemic circulation
Generally presents due to pulmonary oedema
What is Cor Pulmonale?
RVF due to chronic pulmonary arterial hypertension
Often secondary to pulmonary fibrosis
What is congestive HF?
LV + RV failure
What are the features of heart failure?
Breathlessness
Orthopnoea, PND
Fatigue
Oedema
What are the signs of HF?
Displaced apex beat Raised JVP Hepatomegaly Third heart sound Oedema
What will the BNP be in HF?
> 100pg/ml
What does an ECG show?
Arrhythmias/blocks
ST depression
Hypertrophy
What is the gold standard for HF diagnosis?
Echo
What does a CXR show in HF?
Alveolar oedema Kerley B lines Cardiomegaly Dilated upper lobe veins Pleural effusion
Who needs a 2 weeks referral to cardiology for HF? (4)
Previous MI
BNP >400pg/ml
Severe symptoms
Pregnant women
Who needs a 6 week referral to cardiology for HF? (2)
People with BNP 100-400pg/ml
Normal BNP but patient obese or taking diuretics/ACEi/beta-blockers
What is used to measure the severity of HF?
New York Heart Association HF Classification
What are the first line drug treatments for HF?
Bisoprolol 2.5mg
+ Ramipril 2.5mg if LVSD
What must be monitored before starting ACEi?
U+E and eGFR
What are the side effects of ACEi?
Dry cough
Orthostatic hypotension
Hyperkalaemia
What are the side effects of beta-blockers?
Hypotension Bradycardia Sexual dysfunction Asthenia (bisoprolol) Sleep disturbances
What are the second line treatments of HF?
Aldosterone antagonists eg. Eperenone
ARBs eg. valsartan
Hydralaxine + Nitrate - esp if Afro-Caribbean and mod/severe HF
When is digoxin used in HF?
Worsening or severe HF despite 1st and 2nd line treatments
When are diuretics used in HF?
Treatment of fluid overload
Furosemide 40mg
What are the side effects of diuretics?
Hypotension
Polyuria
Dehydration
May aggravate Gout
What are 6 drug classes to avoid in HF?
Calcium channel blockers Tricyclics Lithium NSAIDs Corticosteroids Drugs the prolong QT
