chronic heart failure Flashcards
what is heart failure
when structural or functional abnormalities of the heart cause reduced cardiac output. It is a progressive disease.
Heart failure can either have a reduced or preserved ejection fraction
what are the symptoms of heart failure
- shortness of breath
- persistent coughing and wheezing
- ankle swelling
- reduced exercise tolerance
- fatigue
these symptoms may be accompanied with signs such as:
elevated jugular venous pressure (abnormal right heart dynamics), pulmonary crackles (sounds made when pt inhales), and pulmonary oedema (excess fluid in lungs)
which patient groups have a higher risk of heart failure
- men
- smokers
- diabetics
- risk increases with age
- afro/caribbean patients with hypertension
what is the most common cause of heart failure
coronary heart disease (also known as ischaemic heart disease).
It is when atherosclerotic plaques block/reduce blood flow coronary arteries
name some of the complications that can occur from heart failure
- chronic kidney disease
- atrial fibrillation
- depression
- sudden cardiac death
- sexual dysfunction
- cachexia (weakness/ wasting away of the body due to chronic illness)
what is heart failure with REDUCED ejection fraction
when the left ventricle loses its ability to CONTRACT normally (leading to reduced cardiac output). The patient has an ejection fraction of less than 40%
what is heart failure with PRESERVED ejection fraction
when the left ventricle loses its ability to RELAX normally. The ejection fraction is normal or only mildly reduced
which type of heart failure leads to an ejection fraction of less than 40%
heart failure with REDUCED ejection fraction
what is the New York Heart Association (NYHA) functional classification tool used for
to define how heart failure is progressing based on the severity of symptoms and limitation to physical activity
name some non-drug treatments (lifestyle changes) that can reduce the progression of heart failure
- smoking cessation
- reducing alcohol consumption
- increase exercise if appropriate (150 mins moderate exercise per week. 75 mins if vigorous)
- dietary changes (increase fruit + veg, reduce saturated fat intake)
- max 6g of salt per day
how often should patients with heart failure weigh themselves
weigh themselves everyday at a set time of the day. They should report any weight gain of more than 1.5-2kg in 2 days to their GP or heart failure specialist
when should patients with heart failure report weight gain
if they gain more than 1.5-2 kg in days they should report this to their GP or heart failure specialist
TRUE OR FALSE
patients with heart failure should always reduce/restrict fluid and salt intake
false
fluid and salt intake should only be restricted if they are high
which salt substitutes should be avoided in patients with heart failure
salt substitutes containing potassium to reduce the risk of hyperkalemia
which vaccines are recommended in patients with heart failure
- pneumococcal disease
- annual flu vaccine
which CCBs should be avoided in patients with heart failure
why should they be avoided
all CCB (except amlodipine)
- rate limiting CCB (verapamil + diltazem)
- short acting dihydropyridines CCB (nifedipine + nicardipine)
these should be avoided because they reduce cardiac contractility and exacerbate symptoms
TRUE OR FALSE:
patients with heart failure (with reduced ejection fraction) and angina can safely be treated with amlodipine
True
note: although amlodipine is a dihydropyridine CCB, it is not short acting so can be used. it is the only CCB that can be used in heart failure + angina
why are diuretics be used in patients with heart failure
what is the first-line choice of diuretics
diuretics used to relieve breathlessness + oedema in patients with fluid retention.
first line choice: loop diuretics such as furosemide, bumetanide, torasemide
what the first line treatment for patients with heart failure + reduced ejection fraction
- ACE inhibitor (e.g rampiril, lisinopril, enalapril)
AND
- Beta-blocker (e.g bisoprolol, carvedilol, nebivolol)
- note: you can start either the ACE inhibitor, or BETA blocker first. only start the second addition once the patient has been stable on first drug. start at low dose and titrate up*
what is the next step if a patient with heart failure + reduced ejection fraction still has symptoms despite being on optimal first line treatment
speak to specialist, consider adding:
- an aldosterone antagonist such as spironolactone or eplerenone
- hydralazine
- digoxin
when might digoxin be used in patients with heart failure + reduced ejection fraction
as add-on therapy in worsening or severe heart failure in patients with sinus rhythm.
note: digoxin does not reduce mortality due to heart failure. it only decreases symptoms + decreases hospitalisations due to acute exacerbations
what monitoring should occur when a patient with heart failure + reduced ejection fraction is treated with:
- ACE inhibitors
- ARB
- Aldosterone antagonists
- beta blockers
- serum potassium and sodium
- renal function
- blood pressure
- heart rate
- symptom control
should be checked prior to starting treatment, 1-2 weeks after starting treatment, and at each dose increment. once max dose tolerated, monitor every month for first 3 months, then every 6 months after
what is the treatment for patients with heart failure and preserved ejection fraction
should be treated under care of heart failure specialist
