CHD + HF Flashcards
Causes of high output HF
Anaemia, pregnancy
Hyperthyroidism
Pagets Beri beri
Arteriovenous malformation
Causes RVF then LVF
NY Heart association classification of HF - classes + how else is HF classified?
1 = no limitations
2 = slight limitations, comfortable at rest
3 = less than ordinary activity will lead to symptoms
4 = symptoms when at rest
Also classified as reduced or preserved ejection fraction
Types of HF
Left ventricular = causes a backup, pulmonary oedema
Right ventricular failure = result of left sided HF
Both L + R are systolic
Congestive = mix of LVF + RVF
Most common cause of LVF
Myocardial ischaemia - most common
Common cause of RVF
LVF
Causes of systolic + diastolic HF
Systolic = IHD, MI, cardiomyopathy
Diastolic = constrictive pericarditis, tamponade, restrictive cardiomyopathy, HTN
Causes of low output HF
Pump failure, decreased HR (B blockers)
Negatively inotropic drugs (antiarrhythmics)
Excessive preload (mitrl regurg, fluid overload)
Chronic excessive afterload (aortic stenosis, HTN)
Non pharmacological management of HF
Exercise
Low salt diet
Daily weights
Stop smoking
Alcohol reduction
Flu vaccine
Inform DVLA if large goods vehicle
Pharmacological management of HF
LMNOP if symptomatic
Reduced ejection fraction: ACEi + B blockers (ARBs 2nd line) + Furosemide
In preserved ejection fraction: furosemide + specialist management. Can add: spironolactone, ivabradine, digoxin
AVOID CCB
Consider antiplatelet + statin
Complications of furosemide, cautions + SE
Monitor renal function, electrolytes + BP
Ototoxic + sensitivity to sun
Gout from hyperuricaemia
Hyperglycaemia
Hypokalaemia
Caution in kidney disease, urinary retention, cirrhosis, liver disease
SE of spironolactone
Renal failure
Agranulocytosis
Alopecia
Gynaecomastia, breast pain, changes in libido
Confusion, dizziness
Electrolyte + GI disturbance
Hyperkalaemia - discontinue
SE + cautions of digoxin
Arrhythmias
Blurred vision
Conduction disturbances
Dizziness
GI disturbances
Yellow vision
Eosinophilia + rash
Caution in hypercalcaemia, hypokalaemia, hypomagnesaemia + hypoxia
Monitor plasma conc in renal impairment
SE of ACEi
Hypotension Dry cough GI side effects
Altered LFTs
Monitor U+Es
SE + cautions + CI with B blockers
Prolongs QT
GI disturbance
Bradycardia Hypotension
Sexual dysfunction
Cold extremities
Caution in asthma, diabetes + renal impairment
CI in heart block, uncontrolled asthma or diabetes, unstable HF
What is a TAVI used for?
Transcatheter aortic valve implantation - severe airotic stenosis
Investigations in acute heart failure
ECG Bloods = BNP or NT-proBNP CXR
CXR findings for acute HF
Alveolar oedema
Kerly B lines
Cardiomegaly
Diversion to upper lobes
Effusions
Management of acute HF
Pain = diamorphine
Pee = furosemide 40-80mg IV
Puff = GTN 2 puffs
PAP = CPAP if severe acidaemia/ dyspnoea
Posture = sit up, oxygen
What is QRISK2?
Risk assessment to assess CVD risk
What are common secondary causes of dyslipidaemia?
Excess alcohol
Uncontrolled diabetes
Hypothyroidism
Liver disease
Nephrotic syndrome
How to diagnose CVD?
Measure total + HDL
If total >9 mmol = specialist assessment
How to prevent CVD?
Cardioprotective diet: reduced saturated fat, more wholegrains, reduce sugar, 2 portions of fish, 5 fruit + veg
Exercise
Smoking cessation
Alcohol advice
Atorvastatin 20mg for primary prevention in those with >10% 10 year risk of developing CVD
Primary prevention in T1DM
Offer statins if: >40 y/o
Established nephropathy/ other CVD RF
What is secondary prevention of CVD?
Atorvastatin 80mg in people with CVD
Monitoring whilst on atorvastatin
Measure liver transaminase within 3 months of starting treatment + at 12 months
Aiming for >40% reduction in non-HDL cholesterol
General advice for statins
Check for persistent generalised unexplained muscle pain
Measure CK levels
Contraindicated in pregnancy
ECG results for angina
Pathological Q waves ST + T abnormalities
Management of angina
Beta blockers
Ca channel blockers
GTN spray
Acute LV failure - presentation + pathophysiology
Pulmonary oedema due to increasing pressure in alveoli, causing fluid to leak out
Presentation: PND, orthopnoea, pulmonary congestion, pitting oedema, SOB, pink frothy sputum
Causes of pulmonary oedema
Cardiogenic: LVSD, MI
Non cardiogenic: fluid overload, ARDS
CXR for LVF
ABCD
Alveolar oedema - Bat wing
B - Kerley B lines
Cardiomegaly (should be less than 50%)
Diverted upper lobe vessels
Management of pulmonary oedema
LMNOP
Loop diuretics 40mg furosemide
Morphine (+antiemetic)
Nitrates - GTN spray or infusion if systolic >100
Oxygen
Posture - sit up
How to diagnose chronic HF
ECG - are they in AF?
BNP - brain naturolytic peptide, released by atria under stress - will be high in HF
CXR - ABCD signs
Echo - measures ejection fraction + output
What does inotropic mean + give example of positive + negative inotropes?
Affecting contraction of heart
Positive inotropes increase force of contraction
Digoxin = positive
Negative = beta blockers, diltiazem + verapamil
What does chronotropic mean + give example of positive + negative chronotropes?
Affect heart rate
Positive = adrenaline
Negative = beta blockers, digoxin
Pulsus paradoxus causes
Cardiac tamponade
Pericarditis
Asthma
What is Pulsus bisferiens + what causes it?
Double peak per cardiac cycle
Due to aortic stenosis existing with aortic regurgitation
What is Pulsus alternans and what causes it?
Physical finding of alternating strong and weak beats
Left sided heart failure
What is Unstable vs stable angina?
Stable - occurs with exertion
Unstable - occurs randomly
What is Variant angina?
Also called Prinzmetal’s
Occurs at rest
Caused by spasm of coronary vessels
What is Decubitus angina?
Occurs when patient lies down
Complication of HF
When do you start statins?
CKD, T1DM for more than 10 years, stroke/ TIA
QRISK2 >10%
What is the target cholesterol?
<5
<3 if they have heart problems
What is the most common cause of HF?
Coronary artery disease
Complications of heart failure
Arrhythmias, depression, cachexia, CKD, sexual dysfunction, sudden cardiac death
What are you looking for on a urine dip for someone with HF?
Proteinuria = indicates CKD
What meds should be stopped in HF?
NSAIDs
How is bisoprolol different to atenolol?
More cardioselective
What is involved in annual review for HF?
depression screen, flu jab, BP, med review, bloods (FBC, U+E)
What was the INTERHEART study?
Canadian lead = 9 modifiable RF accounted for >90% of MI
S+S of left sided HF
Fatigue
Syncope
Hypotension
Cool extremities
Slow CRT
Peripheral cyanosis
Pulsus alternans
Mitral regurg
S3
Cough, SOB + crackles
S+S of right sided HF
Same as left + tricuspid regurg + right sided S3
Peripheral oedema, elevated JVP, hepatomegaly, pulsatile liver
5 most common causes of CHF
CAD
HTN
Idiopathic (dilated cardiomyopathy)
Valvulat
Alcohol (dilated cardiomyopathy)
Precipitants of HF exacerbation
Forgot medication
Arrhythmias/ aneia
Ischemia/ infarction/ infection
Lifestyle
Upregulations of cardiac output - pregnancy, hyperthyroidism
Renal failure
Embolism
