Chronic Congestive Heart Failure Flashcards
ESSENCE
Chronic version of acute heart failure
Caused by either impaired left ventricular contraction (systolic heart failure) or left ventricular relaxation (diastolic heart failure)
AETIOLOGY
Main causes
- Ischaemic Heart Disease
- Valvular Heart Disease (commonly aortic stenosis)
- Hypertension
- Arrhythmias (commonly atrial fibrillation)
AETIOLOGY
Risk factors
- MI
- Hypertension
- Diabetes
- Obesity
- Age
- Male
- Left ventricular dysfunction/hypertrophy
- Renal insufficiency
- Valve disease
- Family history
- Cocaine abuse
CLINICAL FEATURES
Presentation
- Breathlessness worse on exertion
- Cough
- Orthopnoea (sensation of shortness of breath when lying flat, relived by sitting up)
- Paroxysmal nocturnal dyspnoea (suddenly waking at night severe attack shortness of breath and cough)
- Peripheral oedema
INVESTIGATIONS
Diagnosis
- Clinical presentation
- BNP blood test (N-terminal pro-B-type natriuretic peptide)
- ECHO
- ECG
What does BNP show
Elevated shows reduced left ejection fraction
MANAGEMENT
General principles
- Refer to specialist (NT-proBNP >2000ng/L warrants urgent referal)
- Medical management
- Surgical treatment in severe aortic stenosis or mitral regurgitation
- Lifestyle advice
- Optimise treatment co-morbidities
MANAGEMENT
First line medical treatment
- Remember ABAL
- ACE inhibitor
- Beta blocker
- Aldosterone antagonist when symptoms not controlled with A and B
- Loop diuretics improves symptoms
ACE inhibitor first choice
Ramipril
Beta blocker first choice
Bisoprolol
Aldosterone antagonist first choice
Spironolactone or eplernone
Loop diuretic first choice
Furosemide
What is used in intolerance to ACE inhibitor
Angiotensin receptor blocker (ARB), such as candesartan
What should be monitored due to drugs used
U&Es monitored closely whilst on diuretics, ACE inhibitors and aldosterone antagonists as they can cause electrolyte disturbances
