Chronic heart failure Flashcards
What are the causes of heart failure?
Valve disease or septal defects
Myocardial disease: CHD, HTN, cardiomyopathy, Drugs (beta blockers, calcium antagonists, anti-arythmics),
Endocrine: DM, thyrouid, cushings etc
Infiltrative: sarcoidosis, amyloidosis, haemochromatosis,
Infective: Chagas disease, HIV
What should be done if there is suspected HF and previous MI?
Specialist assessment and doppler echocardiography within 2 weeks
What should be done if there is suspected HF with no Hx of MI?
Serum BNP
What levels of BNP indicate high, raised and normal?
High = >400 pg/ml Raised = 100-400 pg/ml\ Normal = <100
What levels of NTproBNP indicate high, normal or raised?
High = >2000 pg/ml Raised = 400-2000 pg/ml Normal = <400 pg/ml
What should be done if BNP/NTproBNP are found to be high?
Specialist assessment and doppler echocardiography within 2 weeks
What should be done if BNP/NTproBNP are found to be raised?
Specialist assessment and doppler echocardiography within 6 weeks
What features can reduce BNP/NTproBNP levels?
Obesity
Diuretics
ACEi, Beta-blockers, ARBs, aldosterone antagonists
Raised levels of BNP can be caused by:
LVH, tachycardia, ischaemia, RV overload Hypoxemia Sepsis eGFR <60 COPD Diabetes Age>70 Liver cirrhosis
What investigations can be done to exclude other causes of raised natriuretic peptide?
CXR, peak flow
Bloods - U+E, creatinine/eGFR, TFTs, LFTs, fasting lipids, fasting glucose, FBC, HbA1c
Urinalysis (look for proteinuria
ECG
What is left ventricular systolic dysfunction and what is preserved ejection fraction?
LVSD = <40% Preserved = >40%
Treatment for preserved ejection fraction?
Manage co-morbid conditions:
Loop diuretics (furosemide)
Ca channel blockers (amlodopine) for comorbid HTN or angina
Amiodarone (consult specialist) - needs 6 monthly review
Aspririn if atherosclerotic disease (75-100mg)
Anticoagulants for thrombotic Hx
ACE-i (do not give if suspected valve disease)
Inotropic agents (short term and specialist advice)
Treatment for LVSD?
1st line = ACEi + beta blockers
Consider ARB if intolerant to ACEi, consider hydrazine + nitrate if intolerant to ACEi and ARB
If symptoms persist - seek specialist advice and consider adding aldosterone antagonist or ARB or hydrazine + nitrate (esp. in afro-carribean)
If symptoms still persist - consider pacemaker and digoxin
Invasive procedures
Only offer coronary revascularisation with LVSD if they have refractory angina
Refer for transplant ifs - severe refectory symptoms or refractory cariogenic shock
Lifestyle advice
Exercise (offer rehabilitation)
Snoking, alcohol, sexual activity
Vaccination - yearly flu and one off pneumococcal
