chronic heart failure Flashcards
normal ejection fraction
> 50%
causes of chronic heart failure
ischaemic heart disease
valvular heart disease (aortic stenosis)
hypertension
arrhythmias
cardiomyopathy
presentation of heart failure
breathlessness (worse on exertion)
cough (frothy white/pink sputum)
orthopnoea
paroxysmal nocturnal dyspnoea (gasping for air)
peripheral oedema
fatigue
examination findings in heart failure
tachycardia/tachypnoea/hypertension
murmurs
bilateral basal crackles
raised JVP
peripheral oedema
investigations in chronic heart failure
NT- proBNP blood test- first line
ECG
echocardiogram
bloods
CXR
what is the classification system for heart failure
new york heart association
5 principles of heart failure management
RAMPS
refer to cardiology
advise them about the condition
medical treatment
procedural or surgical interventions
specialist heart failure MDT
when to arrange specialist assessment in chronic heart failure
- levels of NT-proBNP >2000= 2 week echo
- levels 400-2000 = 6 week wait
medical treatment of chronic heart failure
ABAL
first line:
ace inhibitor (ramipril)
**beta blocker (bisoprolol) **
add when reduced EF or not controlled symptoms:
side effect to monitor with ace inhibitors and aldosterone antagonists
hyperkalaemia
second line medication in chronic heart failure
aldosterone antagonist (spironolactone or eplerenone)
loop diuretic (furosemide)
SGLT-2 inhibitor (dapagliflozin)
how do SGLT-2 inhibitors work
reduce glucose reabsorption and increase urinary glucose excretion
third line management of heart failure
initiated by a specialist
ivabradine,
sacubitril-valsartan,
hydralazine in combination with nitrate,
digoxin,
cardiac resynchronisation therapy
what can give someone a falsely low BNP
aldosterone antagonists, ACE inhibitors, angiotensin-II receptor antagonists, beta-blockers and diuretics
management of heart failure patients in resp failure
CPAP
