CCF Flashcards
what are the major criteria for CCF? 9
- paroxysmal nocturnal dyspnoea
- crepitations
- S3 gallop
- cardiomegaly
- increased central venous pressure
- weight loss in response to treatment
- neck vein distention
- acute pulmonary oedema
- hepatojugular reflux
what are the minor criteria for CCF? 7
- bilateral ankle oedema
- dyspnoea or ordinary exertion
- tachycardia
- decrease in vital capacity by 1/3 from maximum recorded
- nocturnal cough
- hepatomegaly
- pleural effusion
which investigations should be carried out for CCF? 6
- ECG
- B-ype natriuretic peptide
- FBC; U &E; BNP
- CXR
- echo
- endomyocardial biopsy is rarely needed
If ECG and B-type natriuretic peptide are normal, heart failure is _____ and an alternative diagnosis should be considered; if either is _____, then echocardiography is required
If ECG and B-type natriuretic peptide are normal, heart failure is unlikely and an alternative diagnosis should be considered; if either is abnormal, then echocardiography is required
what signs are possible of CXR? 8
- cardiomegaly
- prominent upper lobe veins
- peribronchial cuffing
- diffuse interstitial or alveolar shadowing
- bats wing
- fluid in the fissures
- pleural effusions
- septal line (kerley B lines)
what causes the septal lines (kerley B lines)
variously attributed to interstitial oedema and engorged peripheral lymphatics
the ecg may indicate cause, what causes may be shown on ecg?
look for evidence of ischaemia, MI, ventricular hypertrophy
Echocardiography is the key investigation. It may indicate the cause (___, _____-) and can confirm the presence or absence of ___ dysfunction.
Echocardiography is the key investigation. It may indicate the cause (MI, valvular heart disease) and can confirm the presence or absence of LV dysfunction.
specific causes of heart failure and their treatments:
what is the treatment for cor pulmonale?
Rx diuretics and oxygen only
specific causes of heart failure and their treatments:
what is the treatment for valvular disease?
surgery ideally
specific causes of heart failure and their treatments:
what is the treatment for fast AF?
digoxin or DC shock
If you have a bad ____ then drugs are not going to be helpful for you
If you have a bad valve then drugs are not going to be helpful for you
what are the drugs used in CCF? 4/2/3
- diuretics- to excrete retained fluid
- ACE inhibis
- B blockers
- Spironolactone - severe cases only
- digoxin
- other vasodilators (nitrates, hydralazine)
- ICD
- cardiac resynchronisation therapy
- transplantation
what is the first step in management?
lifestyle: stop smoking, eat less salt, optimise weight and nutrition
before drugs, what is done?
Treat the cause
Treat exacerbating factors
Avoid exacerbating factors
what are some exacerbating factors of CCF that should be treated before drug therapy?
anaemia, thyroid disease, infection, increased BP
what are some exacerbating factors of CCF that should be avoided before drug therapy?
NSAIDS (fluid retention) and verapamil (negative inotrope
Thiazide diuretics are used for ___ CCF only
mild
Loop diuretics are used to ____ symptoms
relieve
give an example of a very effective loop diuretic
furosemide
what is a side effect of furosemide?
- you may lose potassium
although furosemide makes you lose K, conincidental drugs like ACE inhibitors, spironolactone help to _____
conincidental drugs like ACE inhibitors, spironolactone help to retain and normalise K
_ levels must be checked regularly. Too high or too low ___ can both cause arrhythmias
K levels must be checked regularly. Too high or too low a K can both cause arrhythmias
In refractory oedema - consider adding a _____
thiazide
ACE should be considered in all people with ____ _____ _____ ______.
ACE should be considered in all people with left ventricular systolic dysfunction.
give some examples of ACE
catopril, enaparil, lisinopril
what are some side effects of ACE
- angioneurotic oedema
- first dose hypertension especially if serum Na are low
- renal impairment
- cough
______ must be monitored after ACEi begun
u and E
Beta blockers : these decrease _____ in heart failure.
These benefits appear to be additional to those of ____ in patients with heart failure due to ____ _______.
Beta blockers
these decrease mortality in heart failure.
These benefits appear to be additional to those of ACEi in patients with heart failure due to LV dysfunction.
when should b blockers be initiated?
after diuretic and ACEi
It is good in the long term but can ____ CCF in short term
It is good in the long term but can worsen CCF in short term
what are the initial risks of b blockers?
hypotension, worsening dyspnoea
give an example of a beta 1 selective beta blocker
bisoprolol
give an example of a non selective beta blocker with alpha blockade
carvedilol
what does spironolactone do?
it is an aldosterone receptor antagonist
spironolactone is used in _____ CCF
severe
spironolactone is ___ sparing but there is a little risk of significant _______, even when given with ACE inhibitors
spironolactone is K sparing but there is a little risk of significant hyperkalaemia, even when given with ACE inhibitors
what are the side effects of spironolactone?
renal dysfunction, gynaecomastia
what does ivabradine do?
slows HR however only does this in sinus rhythm
For example, if in AF (want to reduce HR) - ivabradine will not work.
Only use ivabradine if the HR is fast despite _________
Only use ivabradine if the HR is fast despite B blockers
sacubitral varsartan is a combination of ___ and _______ inhibitor. ______ inhibitor blocks _____ _______ breakdown and boosts ______ ______ (BNP) levels.
is a combination of ARB and Neprilysin inhibitor. Neprilysin inhibitor blocks natriuretic peptide breakdown and boosts natriuretic peptide (BNP) levels.
why are ICDs useful in HF?
some patients may appear to be very well dealing with the HF and then have a sudden death. This is due to arrhythmias.
It is useful to have ICDs - detects heart rhythm and will give an electrical shock to get the rhythm back to normal
for patients with severe HF and a bundle branch block ( meaning that the RV and LV contract milliseconds apart), what is the treatment ?
cardiac resynchronisation therapy.
