Chronic heart failure Flashcards
What is chronic heart failure?
Chronic heart failure refers to impaired heart function, specifically the left ventricle’s inability to pump blood effectively, leading to a backlog of blood and pulmonary oedema.
What is the ejection fraction, and what is considered normal?
The ejection fraction is the percentage of blood squeezed out of the left ventricle with each contraction. An ejection fraction above 50% is normal.
What is the difference between heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF)?
HFrEF has an ejection fraction less than 50%, while HFpEF has an ejection fraction greater than 50%, but impaired filling of the left ventricle (diastolic dysfunction).
What are common causes of chronic heart failure?
Causes include:
* Ischaemic heart disease
* Valvular heart disease (e.g., aortic stenosis)
* Hypertension
* Arrhythmias (e.g., atrial fibrillation)
* Cardiomyopathy
What are the key symptoms of chronic heart failure?
Symptoms include:
* Breathlessness
* Cough (frothy white/pink sputum)
* Orthopnoea
* Paroxysmal nocturnal dyspnoea (PND)
* Peripheral oedema
* Fatigue
What are the typical examination findings in chronic heart failure?
Findings include:
* Tachycardia
* Tachypnoea
* Hypertension
* Heart murmurs
* 3rd heart sound
* Bilateral basal crackles
* Raised jugular venous pressure (JVP)
* Peripheral oedema
What is paroxysmal nocturnal dyspnoea (PND)?
PND is a sudden attack of shortness of breath, cough, and wheeze at night, often relieved by sitting or standing up. It is caused by fluid settling in the lungs when lying flat.
How do you assess chronic heart failure?
Assessment includes:
* Clinical examination
* NT-proBNP blood test
* ECG
* Echocardiogram
* Additional blood tests (e.g., anaemia, renal function, thyroid function)
What is the New York Heart Association (NYHA) classification for heart failure?
The NYHA classification is:
* Class I: No limitation on activity
* Class II: Comfortable at rest, symptomatic with ordinary activities
* Class III: Comfortable at rest, symptomatic with any activity
* Class IV: Symptomatic at rest
What is the “RAMPS” mnemonic for managing chronic heart failure?
RAMPS stands for:
* R – Refer to cardiology
* A – Advise about the condition
* M – Medical treatment
* P – Procedural/surgical interventions
* S – Specialist heart failure MDT input
What are the NT-proBNP thresholds for referral in chronic heart failure?
NT-proBNP thresholds are:
* NT-proBNP 400–2000 ng/L: Seen within 6 weeks
* NT-proBNP >2000 ng/L: Seen within 2 weeks
What vaccines are recommended for patients with chronic heart failure?
Vaccines include:
* Flu
* COVID
* Pneumococcal vaccines
What is the first-line medical treatment for chronic heart failure?
The first-line treatment includes:
* A – ACE inhibitor (e.g., ramipril)
* B – Beta blocker (e.g., bisoprolol)
* A – Aldosterone antagonist (e.g., spironolactone)
* L – Loop diuretics (e.g., furosemide)
When should an angiotensin receptor blocker (ARB) be used in heart failure?
An ARB (e.g., candesartan) is used when an ACE inhibitor is not tolerated.
What additional specialist treatments may be used for heart failure?
Additional treatments may include:
* SGLT2 inhibitors (e.g., dapagliflozin)
* Sacubitril-valsartan (Entresto)
* Ivabradine
* Hydralazine-nitrate
* Digoxin
What are common procedural and surgical interventions for heart failure?
Common interventions include:
* Implantable cardioverter defibrillators (ICDs) for arrhythmias
* Cardiac resynchronisation therapy (CRT) for severe heart failure
* Heart transplant for severe disease
What is cardiac resynchronisation therapy (CRT)?
CRT involves a biventricular pacemaker to synchronise contractions in the heart’s chambers, improving heart function in severe heart failure.
