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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
What is a high NTproBNP level?
> 2000pg/ml (236 pmol/litre)
26
What is another cause of elevated NTproBNP levels?
Renal dysfunction, eGFR < 60
27
How do we manage patients who present with a high BNP level?
It is advised that a specialist assessment echocardiogram is arranged within 2 weeks
28
How are ECHO scans used to diagnose chronic heart failure?
LV ejection fraction
29
What is the LV ejection fraction?
This is the percentage of blood in the ventricle that is pumped out with each ventricular contraction
30
What LV ejection fraction result indicates chronic heart failure?
Reduced
31
What is the normal LV ejection fraction?
50 - 80%
32
What LV ejection fraction result indicates mild heart failure?
40 - 50%
33
What LV ejection fraction result indicates moderate heart failure?
30 - 40%
34
What LV ejection fraction result indicates severe heart failure?
< 30%
35
What are the five signs of heart failure on a CXR?
Alveolar Oedema Kerley B Lines Cardiomegaly Dilated Upper Lobe Vessels Pleural Effusion
36
What scoring system is used to grade the severity and predict the prognosis of chronic heart failure?
‘New York Heart Association’ classification system
37
Define NYHA class I in terms of clinical feature severity and exercise tolerance
Clinical Features - There are no clinical features during activity Exercise Tolerance - No limitation
38
Define NYHA class II in terms of clinical feature severity and exercise tolerance
Clinical Features - There are mild clinical features during activity Exercise Tolerance - Mild limitation
39
Define NYHA class III in terms of clinical feature severity and exercise tolerance
Clinical Features - There are severe clinical features during activity - only comfortable at rest Exercise Tolerance - Moderate limitation
40
Define NYHA class IV in terms of clinical feature severity and exercise tolerance
Clinical Features - There are clinical features present at rest Exercise Tolerance - Severe limitation
41
In what five ways do we conservatively manage chronic heart failure?
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
In what three patient groups do we recommend a booster pneumococcal vaccine every five years?
Those with asplenia Those with splenic dysfunction Those with chronic kidney disease
43
What pneumonic is used to remember pharmacological management of chronic heart failure?
ABAS ACE Inhibitors Betablockers Aldosterone antagonists Specialist referral
44
What is the first line treatment option for chronic heart failure?
ACE Inhibitor (or ARB) AND Betablocker
45
Which three ACE inhibitors are usually administered to treat chronic heart failure?
Ramipril Enalapril Lisinopril
46
How do ACE inhibitors manage chronic heart failure?
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
In which patient group are ACE inhibitors contraindicated?
Those with valvular heart disease
48
What is administered when ACE inhibitors are contraindicated or not tolerated? Name a specific drug
ARBs Candesartan
49
Which three betablockers are usually administered to treat chronic heart failure?
Bisoprolol Carvediol Nebivolol
50
How do betablockers manage chronic heart failure?
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
What is the second line treatment option for chronic heart failure?
Aldosterone antagonists
52
Which two aldosterone antagonists are administered to treat chronic heart failure?
Spironolactone Eplerenone
53
How do aldosterone antagonists manage chronic heart failure?
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
What effect do both ACE inhibitors and aldosterone antagonists have on potassium levels? How do we manage this?
Increase levels - hyperkalaemia We monitor potassium levels regularly in patients who are administered both
55
What are the four third line treatment option of chronic heart failure?
Ivabradine Sacubitril-Valsartan Digoxin Hydralazine + Nitrates
56
What is the mechanism of action ivabradine?
It is a heart lowering agent, used to reduce the risk of sinus bradycardia
57
When is ivabradine considered to manage chronic heart failure?
It is a third line management option, in cases where patients have a heart rate > 75
58
What is a side effect of ivabradine?
Visual disturbances, such as phosphenes and green luminescence
59
What is sacubitril-valsartan?
It is a combined drug of valsartan, ARB and neprilysin
60
When is hydralazine and nitrate recommended to manage chronic heart failure?
It is a third line management option, particularly effective in Afro-Carribean patients
61
Who administers third line treatment options of chronic heart failure?
Specialists
62
Which medication is contraindicated in individuals with heart failure? Why?
Pioglitazone It can cause fluid retention
63
What are the five complications of chronic heart failure?
Stroke Valvular Heart Disease Pneumonia Renal Failure Ulcerated Cellulitic Legs
64
What two valvular heart diseases are associated with chronic heart failure?
Mitral Regurgitation Tricuspid Regurgitation
65
What is cor pulmonale?
It is defined as right sided heart failure caused by respiratory disease
66
Describe the pathophysiology of cor pulmonale
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
What are the five causes of cor pulmonale?
COPD Pulmonary Embolism Interstitial Lung Disease Cystic Fibrosis Primary Pulmonary Hypertension
68
What is the main cause of cor pulmonale?
COPD
69
What are the eight clinical features of cor pulmonale?
Dyspnoea Peripheral Oedema Syncope Chest Pain Increased JVP 3rd Heart Sound Tricuspid Regurgitation Murmur Hepatomegaly
70
What is the main distinguishing feature of cor pulmonale?
Hepatomegaly
71
What are the two features of hepatomegaly in cor pulmonale?
It is pulsatile in tricuspid regurgitation The liver edge is firm, tender and smooth
72
How do we manage cor pulmonale?
We treat the underlying cause and manage the presenting clinical features
73
Which drug is contraindicated in individuals with heart failure?
Cyclizine

Year One - Cardiovascular System (20 decks)

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