Chronic heart failure Flashcards
What is heart failure?
Pump failure
What are the main symptoms of chronic heart failure?
- Breathlessness, worsened by exertion
- Cough (frothy white/pink sputum)
- Orthopnoea
- Paroxysmal nocturnal dyspnoea
- Peripheral oedema (swollen ankles)
How is chronic heart failure diagnosed?
- Clinical presentation
- BNP
- Echocardiogram
What is BNP?
A hormone released by the cardiomyocytes when the myocardium is stretched beyond the normal range
What is meant by ejection fraction? What is considered a normal ejection fraction?
Ejection fraction is the volume of blood in the left ventricle that is pumped out with each contraction
An ejection fraction above 50% is considered normal
What are the main causes of chronic heart failure?
- IHD
- HTN
- AF
- Valvular heart disease (commonly AS)
Describe the medical management of chronic heart failure
ABAL:
- ACEi (titrated up as tolerated) PLUS Beta blocker (titrated up as tolerated)
- Aldosterone antagonist (if above is insufficient)
- Loop diuretics, e.g. furosemide (for oedema)
What system is used to classify the severity of chronic heart failure?
Describe the classification system
New York Heart Association (NYHA) Classification System:
- Class I: no limitation of physical activity
- Class II: mild limitation of physical activity
- Class III: marked limitation of physical activity
- Class IV: unable to carry out any physical activity without discomfort; symptoms of HF at rest
What is cor pumonale?
Right heart failure caused by respiratory disease
List some of the conditions which can cause cor pulmonale
- COPD (most common)
- Interstitial lung disease
- Cystic fibrosis
- Primary pulmonary HTN
Describe the typical CXR findings in chronic heart failure
ABCDEF: A - alveolar oedema B - kerley B lines C - cardiomegaly D - upper lobe Diversion E - pleural Effusion F - fluid in the horizontal fissure
