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A13THP @ UoN > Chronic Heart Failure > Flashcards

Chronic Heart Failure Flashcards

1
Q

Define Heart Failure

A

Failure of the heart as a pump to meet the circulatory needs

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2
Q

What are the two components of the heart that may fail?

A

Heart Muscle

Heart Valves

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3
Q

What are the two main classifications of Heart Failure?

A

Chronic

Acute

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4
Q

What are the most common causes of Heart Failure?

A

Hypertension (hypertrophy, increased cardiac work)
IHD (impaired muscle)
Cardiomyopathies (alcohol, viral)

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5
Q

What factors may precipitate Heart Failure?

A

Pregnancy
Anaemia
Hyper-/Hypo-thyroidism
Fluid retaining drugs (NSAIDs, glucocorticoids)

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6
Q

What are the four neurohormonal responses as a compensation for circulatory failure?

A

Activation of SNS
Activation of RAAS
Activation of ADH (Anti Diuretic Hormone)
Activation of ANP (Atrial Natriuretic Protein)

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7
Q

What are the effects of neurohormonal adaptation?

A

Increased afterload
Increased circulating volume
Increased resistance - impaired renal func - salt/water retention - activation of RAAS
MYOCYTE DYSFUNCTION

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8
Q

Describe Left-Sided Heart Failure

A

Impairment of LV (poor output) leading to increased LA/pulmonary venous pressure (pulmonary oedema)
Secondary to hypertension

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9
Q

Describe Right-Sided Heart Failure

A

Impairment of RV (poor output) leading to increased RA pressure
Secondary to lung disease (cor pulmonale) or pulmonary valvular stenosis

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10
Q

Describe Biventricular Failure

A

Impairment of both chambers
Can be due to IHD of both ventricles
LVF leads to pulmonary congestion, can lead to RVF

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11
Q

What are the signs/symptoms of Heart Failure?

A 
Fatigue
Poor exercise tolerance (grading)
Cold peripheries
Low BP
Reduced urine
Weight loss
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12
Q

What signs/symptoms are specific to LVF?

A

Pulmonary Oedema

  • Dyspnoea w/ sensation of drowning
  • Orthopnoea
  • Cough
  • Inspiratory crepitations
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13
Q

What signs/symptoms are specific to RVF?

A

Raised venous pressure
Increased JVP
Enlarged liver
Peripheral oedema

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14
Q

What diagnostic signs are needed to confirm a diagnosis of Heart Failure?

A

Ejection Fraction <45% (echocardiogram)

BNP levels

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15
Q

What signs of Heart Failure are present on a CXR?

A

Cardiomegaly
Pulmonary oedema
Kerley’s lines (lymphatic distension)

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16
Q

What is Atrial Fibrillation?

A

A condition where the LA has multiple pacemaker signals

An abnormal heart rate characterised by rapid and irregular beating

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17
Q

What is the most common cause of Atrial Fibrillation?

A

LV/valve failure - increased LA pressure - distension - Atrial Fibrillation

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18
Q

What is the major risk with Atrial Fibrillation?

A

Stasis of blood - thrombi formation - risk of TIA

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19
Q

How should Atrial Fibrillation be treated prophylactically?

A

Prophylaxis against thromboembolism

Warfarin/Aspirin

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20
Q

What are the main goals when treating Heart Failure?

A 
Treat any cause
Reduce cardiac workload
Increase cardiac output
Counteract maladaptation
Relieve symptoms
Prolong quality life
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21
Q

How is pharmacological management for Heart Failure decided?

A

Stage dependent

22
Q

What should patients with Left Ventricular Systolic Dysfunction be treated with?

A

ACEIs

23
Q

What should patients with Oedema be treated with?

A

Diuretics

24
Q

What should patients with moderate/stable Heart Failure be treated with?

A

Beta-Blockers

25
Q

Why are ACEIs effective in LVSD?

A

Reduce arterial/venous vasocoonstriction
Reduce salt/water retention
Inhibit RAAS system (oppose neurohormonal adaptation)

26
Q

Give several examples of ACEIs

A

Ramipril, Lisinopril, Enalapril

27
Q

How should ACEI dosing be controlled?

A

Start with a low dose then titrate up

28
Q

What drug class should ACEIs not be used with?

A

NSAIDs

29
Q

What should be monitored before and during treatment with ACEIs?

A

Urea/Creatinine

K+

30
Q

When should ACEIs be avoided?

A

Hypotension (<100mg sys)

Renal failure

31
Q

What are the most common problems with ACEIs?

A

Severe hypotension
Cause renal damage
Hyperkalaemia

32
Q

How do ATRAs work?

A

Oppose actions of AII at the AT1 receptor

33
Q

Give examples of ATRAs

A

Candesartan
Valsartan
Losartan

34
Q

When are diuretics used to treat Heart Failure?

A

When oedema is present

35
Q

What sort of diuretics are used to treat Heart Failure?

A 
Thiazides (bendroflumethiazide) - mild failure/elderly
Loop Diuretics (Furosemide) - pulmonary oedema
36
Q

How do diuretics work?

A

Reduction in circulating volume
Reduce pre-/after-load
Venodilation

37
Q

What is the major problem with diuretics?

A

May cause hypokalaemia

38
Q

When are Beta-Blockers used to treat Heat Failure?

A

Stable/moderate failure

Esp. useful when associated with Ischaemia

39
Q

How do Beta-Blockers work?

A

Reduce sympathetic stimulation/hear rate/O2 use
Antiarrhythmic
Oppose neurohormonal activation

40
Q

How should Beta-Blocker dosing be controlled?

A

Start with low dose and increase

41
Q

What may be the immediate response to treatment with Beta-Blockers?

A

Symptoms may get worse at first

42
Q

What is Spironolactone?

A

Aldosterone receptor antagonist

43
Q

How is Spronolactone used?

A

Reverses left ventricular hypertrophy

Inhibits effects of aldosterone on heart (ie. fibrosis)

44
Q

What is Digoxin?

A

Positive inotrope causing heart block and bradycardia

45
Q

How does Digoxin work?

A

Inhibits Na+/K+ ATPase
Na accumulates - exchanged with Ca
INCREASED CONTRACTILITY
Impairs AV conduction, increases vagal activity

46
Q

When is Digoxin used to treat Heart Failure?

A

Heart failure with atrial fibrillation

47
Q

How should Digoxin dosing be controlled?

A

Titrate dose, ensure ventricular rate doesn’t fall below 60BPM

48
Q

What drugs are contraindicated in renal failure?

A

Thiazides - ineffective

ACEIs - impair renal function

49
Q

Why should Potassium be monitored during treatment?

A

Thiazides/Loop Diuretics cause Hypokalaemia
Enhances effect of Digoxin
ACEIs w/ K+ sparing diuretic causes Hyperkalaemia

50
Q

Describe Digoxin toxicity?

A

Narrow therapeutic window
Anorexia, nausea, visual disturbances, diarrhoea
Pulse <60BPM

A13THP @ UoN (19 decks)

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