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Year One - Cardiovascular System > Chronic Heart Failure > Flashcards

Chronic Heart Failure Flashcards

1
Q

What is chronic heart failure?

A

It is a chronic condition in which the cardiovascular system fails to pump sufficient quantities of blood to meet the physiological demands of the body

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2
Q

Chronic heart failure causes a back flow of blood in which three locations?

A

Left atrium

Pulmonary veins

Lungs

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3
Q

What are the five causes of chronic heart failure?

A

Ischaemic Heart Disease

Valvular Heart Disease

Cardiomyopathy

Hypertension

Arrythmias

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4
Q

What is the main cause of chronic heart failure?

A

Ischaemic heart disease

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5
Q

What valvular heart disease is most commonly associated with chronic heart failure?

A

Aortic stenosis

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6
Q

What arrhythmia is most commonly associated with chronic heart failure?

A

Atrial fibrillation

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7
Q

What are the six symptoms of chronic heart failure?

A

Dyspnoea on Exertion

Cough with White/Pink Sputum

Orthopnoea

Paroxysmal Nocturnal Dyspnoea

Peripheral Oedema

Ascites

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8
Q

What is orthopnea?

A

It describes shortness of breath experienced when patient’s are lying flat

It is usually relieved by sitting or standing

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9
Q

What is paroxysmal nocturnal dyspnoea?

A

It describes a severe attack of shortness of breath during the night - which wakes the patient up

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10
Q

What are the six signs of chronic heart failure?

A

Tachycardia

Tachypnoea

Hypoxemia

3rd Heart Sound

Bilateral Basal Cracks

Increased JVP

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11
Q

What system is used to diagnose chronic heart failure?

A

Framingham Criteria for Congestive Heart Failure

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12
Q

What ‘Framingham Criteria for Congestive Heart Failure’ score is required to diagnose chronic heart failure?

A

2 major criteria

OR

1 major criterion and 2 minor criteria

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13
Q

What are the five major criteria of the ‘Framingham Criteria for Congestive Heart Failure’?

A

PAINS

Paroxysmal Nocturnal Dyspnoea

Acute Pulmonary Oedema

Increased Heart Size/Increased Central Venous Pressure

Neck Vein Dilatation

S3 Gallop

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14
Q

What are the four minor criteria of the ‘Framingham Criteria for Congestive Heart Failure’?

A

PAIN

Pleural Effusion

Ankle Oedema (Bilateral)

Increased Heart Rate >120bpm

Nocturnal Cough

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15
Q

What three investigations are used to diagnose chronic heart failure?

A

Blood Tests

Echocardiogram (ECHO)

Chest X-Ray (CXR)

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16
Q

What blood test is used to diagnose chronic heart failure?

A

N-terminal pro-B-type natriuretic peptide (NT-proBNP)

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17
Q

What is BNP?

A

It is a hormone that is released from the heart ventricles when the myocardium is stretched beyond normal range

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18
Q

What is the function of BNP?

A

To relax the smooth muscles in blood vessels, which reduces the systemic vascular resistance and makes it easier for the heart to pump blood

To promote the excretion of water in urine, which reduces circulating volume and improves cardiac function

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19
Q

What is the normal BNP level?

A

< 100 pg/ml

(29pmol/litre)

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20
Q

What is the normal NTproBNP level?

A

< 400pg/ml

(47 pmol/litre)

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21
Q

What is an elevated BNP level?

A

100 – 400 pg/ml

(29 – 116pmol/litre)

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22
Q

What is an elevated NTproBNP level?

A

400 – 2000/ml

(47 - 236pmol/litre)

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23
Q

How do we manage patients who present with an elevated BNP level?

A

It is advised that a specialist assessment echocardiogram is arranged within 6 weeks

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24
Q

What is a high BNP level?

A

> 400 pg/ml

(116pmol/litre)

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25
Q

What is a high NTproBNP level?

A

> 2000pg/ml

(236 pmol/litre)

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26
Q

What is another cause of elevated NTproBNP levels?

A

Renal dysfunction, eGFR < 60

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27
Q

How do we manage patients who present with a high BNP level?

A

It is advised that a specialist assessment echocardiogram is arranged within 2 weeks

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28
Q

How are ECHO scans used to diagnose chronic heart failure?

A

LV ejection fraction

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29
Q

What is the LV ejection fraction?

A

This is the percentage of blood in the ventricle that is pumped out with each ventricular contraction

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30
Q

What LV ejection fraction result indicates chronic heart failure?

A

Reduced

31
Q

What is the normal LV ejection fraction?

A

50 - 80%

32
Q

What LV ejection fraction result indicates mild heart failure?

A

40 - 50%

33
Q

What LV ejection fraction result indicates moderate heart failure?

A

30 - 40%

34
Q

What LV ejection fraction result indicates severe heart failure?

A

< 30%

35
Q

What are the five signs of heart failure on a CXR?

A

Alveolar Oedema

Kerley B Lines

Cardiomegaly

Dilated Upper Lobe Vessels

Pleural Effusion

36
Q

What scoring system is used to grade the severity and predict the prognosis of chronic heart failure?

A

‘New York Heart Association’ classification system

37
Q

Define NYHA class I in terms of clinical feature severity and exercise tolerance

A

Clinical Features - There are no clinical features during activity

Exercise Tolerance - No limitation

38
Q

Define NYHA class II in terms of clinical feature severity and exercise tolerance

A

Clinical Features - There are mild clinical features during activity

Exercise Tolerance - Mild limitation

39
Q

Define NYHA class III in terms of clinical feature severity and exercise tolerance

A

Clinical Features - There are severe clinical features during activity - only comfortable at rest

Exercise Tolerance - Moderate limitation

40
Q

Define NYHA class IV in terms of clinical feature severity and exercise tolerance

A

Clinical Features - There are clinical features present at rest

Exercise Tolerance - Severe limitation

41
Q

In what five ways do we conservatively manage chronic heart failure?

A

To Receive The Influenza Vaccine Yearly

To Receive A One-Off Pneumococcal Vaccine

To Stop Smoking

To Optimise Treatment of Co-Morbidities

To Exercise Regularly

42
Q

In what three patient groups do we recommend a booster pneumococcal vaccine every five years?

A

Those with asplenia

Those with splenic dysfunction

Those with chronic kidney disease

43
Q

What pneumonic is used to remember pharmacological management of chronic heart failure?

A

ABAS

ACE Inhibitors

Betablockers

Aldosterone antagonists

Specialist referral

44
Q

What is the first line treatment option for chronic heart failure?

A

ACE Inhibitor (or ARB)

AND

Betablocker

45
Q

Which three ACE inhibitors are usually administered to treat chronic heart failure?

A

Ramipril

Enalapril

Lisinopril

46
Q

How do ACE inhibitors manage chronic heart failure?

A

These drugs prevent the activation of the RAAS system, through inhibition of the angiotensin converting enzyme (ACE)

This reduces the preload and afterload of the heart, thus preserving the LV ejection fraction

This improves clinical features and decreases mortality

47
Q

In which patient group are ACE inhibitors contraindicated?

A

Those with valvular heart disease

48
Q

What is administered when ACE inhibitors are contraindicated or not tolerated? Name a specific drug

A

ARBs

Candesartan

49
Q

Which three betablockers are usually administered to treat chronic heart failure?

A

Bisoprolol

Carvediol

Nebivolol

50
Q

How do betablockers manage chronic heart failure?

A

These drugs activate the sympathetic activation, through inhibition of the beta-adrenergic receptors

This reduces the preload and afterload of the heart, thus preserving the LV ejection fraction

This improves clinical features and decreases mortality

51
Q

What is the second line treatment option for chronic heart failure?

A

Aldosterone antagonists

52
Q

Which two aldosterone antagonists are administered to treat chronic heart failure?

A

Spironolactone

Eplerenone

53
Q

How do aldosterone antagonists manage chronic heart failure?

A

These drugs prevent the activation of the RAAS system, through inhibition of the aldosterone receptors

This reduces the preload and afterload of the heart, thus preserving the LV ejection fraction

This improves clinical features and decreases mortality

54
Q

What effect do both ACE inhibitors and aldosterone antagonists have on potassium levels? How do we manage this?

A

Increase levels - hyperkalaemia

We monitor potassium levels regularly in patients who are administered both

55
Q

What are the four third line treatment option of chronic heart failure?

A

Ivabradine

Sacubitril-Valsartan

Digoxin

Hydralazine + Nitrates

56
Q

What is the mechanism of action ivabradine?

A

It is a heart lowering agent, used to reduce the risk of sinus bradycardia

57
Q

When is ivabradine considered to manage chronic heart failure?

A

It is a third line management option, in cases where patients have a heart rate > 75

58
Q

What is a side effect of ivabradine?

A

Visual disturbances, such as phosphenes and green luminescence

59
Q

What is sacubitril-valsartan?

A

It is a combined drug of valsartan, ARB and neprilysin

60
Q

When is hydralazine and nitrate recommended to manage chronic heart failure?

A

It is a third line management option, particularly effective in Afro-Carribean patients

61
Q

Who administers third line treatment options of chronic heart failure?

A

Specialists

62
Q

Which medication is contraindicated in individuals with heart failure? Why?

A

Pioglitazone

It can cause fluid retention

63
Q

What are the five complications of chronic heart failure?

A

Stroke

Valvular Heart Disease

Pneumonia

Renal Failure

Ulcerated Cellulitic Legs

64
Q

What two valvular heart diseases are associated with chronic heart failure?

A

Mitral Regurgitation

Tricuspid Regurgitation

65
Q

What is cor pulmonale?

A

It is defined as right sided heart failure caused by respiratory disease

66
Q

Describe the pathophysiology of cor pulmonale

A

In individuals with respiratory disease, pulmonary hypertension can occur, in which there is an increased pressure and resistance in the pulmonary arteries

This results in the right ventricle being unable to effectively pump blood out of the ventricle and into the pulmonary arteries

This ultimately leads to a back pressure of blood in the right atrium, the vena cava and the systemic venous system

67
Q

What are the five causes of cor pulmonale?

A

COPD

Pulmonary Embolism

Interstitial Lung Disease

Cystic Fibrosis

Primary Pulmonary Hypertension

68
Q

What is the main cause of cor pulmonale?

A

COPD

69
Q

What are the eight clinical features of cor pulmonale?

A

Dyspnoea

Peripheral Oedema

Syncope

Chest Pain

Increased JVP

3rd Heart Sound

Tricuspid Regurgitation Murmur

Hepatomegaly

70
Q

What is the main distinguishing feature of cor pulmonale?

A

Hepatomegaly

71
Q

What are the two features of hepatomegaly in cor pulmonale?

A

It is pulsatile in tricuspid regurgitation

The liver edge is firm, tender and smooth

72
Q

How do we manage cor pulmonale?

A

We treat the underlying cause and manage the presenting clinical features

73
Q

Which drug is contraindicated in individuals with heart failure?

A

Cyclizine

Year One - Cardiovascular System (20 decks)

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