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Case 9 Congestive Cardiac Failure > CCF > Flashcards

CCF Flashcards

1
Q

What is dyspnoea?

A

Refers to a state where the subject is uncomfortably aware of his/her breathing. Associated with reduced lung compliance or increased respiratory rate.

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2
Q

What are features of RHF?

A

Ascites, peripheral oedema (up to thighs, sacrum and abdominal wall), hepatomegaly, raised JVP, nausea, anorexia, facial engorgement, epistaxis

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3
Q

What are features of LHF?

A

dyspnoea, PND, orthopnoea, poor exercise tolerance, fatigue, nocturnal cough, wheeze, nocturia, cold peripheries, weight loss

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4
Q

What is the ‘a’ wave in the jugular venous wave

A

Right atrial contraction

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5
Q

What causes the c wave in the jugular venous wave?

A

bulging of the tricuspid valve in ventricular systole

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6
Q

What causes the v wave?

A

increased blood in the RA from venous return

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7
Q

What is a grade 4 murmur?

A

A loud murmur with a palpable thrill.

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8
Q

When should a follow-up assessment take place following discharge?

A

within 2 weeks

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9
Q

What tests and imaging are used to diagnose HF? (5)

A 
Blood test - FBC, haematinics, U&E, TFT, glucose, BNP, Trop-I, LFTs
ABGs
ECG
CXR
Transthoracic echo
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10
Q

Why is an echo performed?

A

establish the presence or absence of cardiac abnormalities.

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11
Q

How is acute HF initially managed?

A

IV diuretic therapy or IV nitrates

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12
Q

When should non-invasive ventilation be offered?

A

A patient with severe dyspnoea and acidaemia

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13
Q

What is the NICE definition of heart failure?

A

a complex syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump to support a physiological circulation

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14
Q

What is the most common cause of HF?

A

Ischaemic heart disease

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15
Q

What is systolic failure?

A

Inability of the ventricle to contract normally, resulting in reduced cardiac output. Ejection fraction (EF) is <40%.

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16
Q

What is diastolic failure?

A

inability of the ventricle to relax and fill normally, causing increased filling pressures. Typically EF is >45%, this is termed HFpEF (heart failure with preserved EF).

17
Q

What are the main causes of RV failure?

A

LVF, pulmonary stenosis, lung disease

18
Q

What is acute HF?

A

new-onset acute or decompensation of chronic heart failure characterised by pulmonary and or peripheral oedema

19
Q

What is chronic HF?

A

HF that develops or progresses slowly. Venous congestion is common.

20
Q

What is the scale used for dyspnoea?

A

NYHA

21
Q

What is NYHA stage 4?

A

Symptoms at rest

22
Q

What is NYHA?

A

Marked limitation in activity due to symptoms

23
Q

What is used to diagnose CCF?

A

Framingham Diagnostic criteria. Two major or one major and two minor required.

24
Q

What are the major criteria for CCF? (7)

A

Acute pulmonary oedema, cardiomegaly, hepatojugular reflux, neck vein distension, PND or orthopnoea, rales/crackles, S3 gallop

25
Q

What are the minor criteria for ccF? (6)

A

ankle oedema, dyspnoea on exertion, hepatomegaly, nocturnal cough, pleural effusion, HR >120 bpm

26
Q

Why is an echo performed?

A

Helps define aetiology of HF.

Provides information regarding the ejection fraction of the LV.

27
Q

What can be seen on CXR?

A

cardiac size, presence of oedema, pleural effusion, consolidation

28
Q

How is HF with impaired systolic function treated? (6)

A

Diuretics, ACE-I, beta-blockers, aldosterone receptor antagonists, devices: CRT/ICD

29
Q

How is HF with preserved systolic function treated?

A

diuretics,

treatment of co-morbidities

30
Q

When are Aldosterone receptor antagonists used?

A

in treatment of severe LV dysfunction (EF <35%, NYHA II)

31
Q

What does Cardiac re-synchronisation therapy (CRT) do?

A

Improves synchronicity between LV and RV and within LV

32
Q

How do Implantable cardiac defibrillators (ICD) work?

A

detect and treat ventricular arrhythmias by:

  • Attempting to overdrive pace VT
  • Deliver shock to cardiovert VT/VF
33
Q

How is acute pulmonary oedema managed? (4)

A

1) Sit patient up
2) Non-invasive positive pressure ventilation (CPAP)
3) IV GTN
4) Furosemide IV 40mg BD

34
Q

What approach is taken if patient has been in AF for longer >48hrs or unknown onset?

A

control the rate with appropriate medication and anti-coagulate the patient

35
Q

What 3 features are required to diagnose HF?

A

Symptoms - breathless, fatigue

+

Signs - tachycardia, raised jvp, pulmonary congestion, peripheral oedema

+

Objective evidence - echocardiographic evidence, S3, cardiomegaly

36
Q

What are the typical x-ray findings in CXR? (5)

A 
alveolar shadowing
kerley 'b' lines
cardiomegaly
dilated upper lobe vessels
enlarged hilar vessels

Case 9 Congestive Cardiac Failure (3 decks)

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