Chronic Heart Failure Flashcards
Mechanism of heart failure
Impaired left ventricular contraction or left ventricular relaxation. Causes chronic back pressure of blood trying to flow
Presentation of chronic heart failure
breathlessness worsened by exertion, cough, orthopnoea, parapxysmal nocturnal dysopnoea, peripheral oedema
Diagnosis of chronic HF
Clinical presentation, BNP blood test, echo, ECG
Causes of chronic HF
Ischaemic heart disease, valvular heart disease, hypertension, arrhythmias (commonly AF)
Management of HF
Refer to specialist, careful discussion and explanation, medical management, surgical treatment, HF specialist nurse
Medical management of chronic HF
ACEI, Bete blocker, Aldosterone antagonist if not controlled, loop diuretics to improve symptoms
Eg of ACEI used in HF
Ramipril up to 10mg daily
Eg of beta blocker used in HF
Bisoprolol up to 10mg daily
Eg of aldosterone antagonist used
Spironolactone or eplerenone
Eg of loop diuretic used in HF
Furosemide up to 40mg
What is an option if ACEIs are not tolerated
ARBs such as candesartan
What needs to be monitored due to medication
U&Es as diuretics, ACEI and aldosterone antagonists can cause electrolyte disturbances
When would you add an aldosterone antagonist
When there is reduce ejection fraction and symptoms are not controlled with ACEI and BB
What is right sided heart failure
Cor pulmonale
What is the disease process of right sided heart failure
Caused by respiratory disease where the increased pressure and resistancein the pulmonary arteries results in the right ventricle being unable to effectively pump blood out, causing back pressure in right atrium and systemic venous system
What is the disease process of right sided heart failure
Caused by respiratory disease where the increased pressure and resistancein the pulmonary arteries results in the right ventricle being unable to effectively pump blood out, causing back pressure in right atrium and systemic venous system
Respiratory causes of right sided heart failure
COPD (most common), PE, interstitial lung disease, cystic fibrosis, primary pulmonary hypertension
Presentation of right sided heart failure
SOB, peripheral oedema, breathlessness on exertion,syncope and chest pain. Can be asymptomatic
Examination signs of cor pulmonale
Hypoxia, cyanosis, raised JVP, peripheral oedema, third heart sound, murmurs, hepatomegaly
Management of cor pulmonale
Treating symptoms and underlying cause, LTOT.
ECG findings of heart failure
Tachycardia, AF, left axis deviation, P wave changes, wide QRS, prolonged PR interval - can be normal or identify cause
ECHO of heart failure
<40% = reduced ejection fraction
<40% but raised BNP = preserved ejection fraction
CXR findings in heart failure (ABCDEF)
Alveolar oedema
Kerley B lines
Cardiomegaly
Dilated upper lobe vessels
Effusions
Fluid in horizontal fissure
