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1ST YEAR SYSTEMS: Cardiovascular > Chronic heart failure > Flashcards

Chronic heart failure Flashcards

1
Q

Define heart failure

A

A clinical syndrome comprising of dyspnoea, fatigue
or fluid retention due to cardiac dysfunction, either at
rest or on exertion, with accompanying
neurohormonal activation

not a final diagnosis - underlying condition that is causing it

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2
Q

prevalence of HF in UK?

A

1-2 %

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3
Q

why is the prevalence of HF in the UK increasing?

A

due to:-
treatment of AMI (heart attack)
aging population

incidence/prevalence of things like hypertension, CHD, obesity, diabetes

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4
Q

what is the one-year survival rate for heart failure worse than?

A

breast cancer
uterus
prostate
bladder

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5
Q

What can be said about re-admission rates for HF?

A

High! and readmission is most likely to happen early.

Length of hospital admission is longer than any other condition.

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6
Q

What are the symptoms of heart failure?

A

breathlessness
Fatigue
Odema
Reduced exercise capacity

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7
Q

What are the signs of heart failure?

A

Oedema

Tachycardia

Raised JVP

Chest crepitations or effusions

3rd Heart sound

Displaced or abnormal apex beat

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8
Q

Is heart failure easy to diagnose based on clinical signs alone?

A

no, it is very difficult!

diagnosis incorrect in approximately 40-50% of cases

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9
Q

3 things you need to consider to diagnose heart failure?

A

Symptoms or signs of HF (rest or exercise)

Objective evidence of cardiac dysfunction (in doubtful cases)

Response to therapy (diuretics)

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10
Q

what tests can give objective evidence of a diagnosis of HF?

A

ECHO - key, may show cause ie MI, valvular heart disease
Radionucleotide Scan
Left Ventriculogram
Cardiac MRI

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11
Q

potential screening tests for heart failure

A

12 Lead ECG

BNP (brain (B-type) natriuretic peptide

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12
Q

what is a 12 Lead ECG and how does it give evidence of heart failure?

A

test that uses 10 electrodes to generate 12 different views of the heart’s electrical activity.

LV Systolic Dysfuntion very unlikely if ECG normal (90-95% sensitive)
• Problems with confidence of interpretation in primary care, must be entirely normal or else loses reliability

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13
Q

what is BNP and how does it give evidence of heart failure?

A

BNP is a hormone secreted by cardiomyocytes in the heart ventricles in response to stretching caused by increased ventricular blood volume.

BNP levels go up in heart failure

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14
Q

why is BNP a good test?

A

Highly sensitive test for HF, stable for up to 72 hours, ‘bedside’ testing available if desired, relatively inexpensive

Low BNP effectively rules out heart failure or LVSD, elevated BNP indicates need for an echo/cardiac assessment

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15
Q

what other reasons are there for an elevated BNP?

A

AF
Elderly
Valve Disease

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16
Q

What investigations/tests are carried out to look for CHF/HF? (7)

A 
FBC - BNP levels - raised in HF
ECHO 
fasting blood glucose
serum urea
electrolytes
urinalysis - myoglobin
thyroid function
CXR
17
Q

what things are you looking for in the clinical examination for HF diagnosis? (5)

A

rales - abnormal lung sounds - discontinuous clicking/rattling
bilateral ankle oedema
heart murmur
jugular venous dilatation
laterally displaced/ broadened apical beat

18
Q

Give examples of structural heart diseases that, if severe enough, can cause heart failure?

A

LV systolic dysfunction – many causes

Valvular heart disease

Pericardial constriction or effusion

LV diastolic dysfunction/heart failure with preserved systolic function/heart failure with normal ejection fraction

Cardiac arrhythmias: tachy or brady

Myocardial ischaemia/infarction (usually via LVSD)

Restrictive cardiomyopathy eg amyloid, HCM

Right ventricular failure: primary or secondary to pul
hypertension

19
Q

Causes of LV systolic dysfunction

A

ischaemic heart disease
severe Aortic Valve disease or MR
Dilated cardiomyopathy (DCM): Means LVSD not due to IHD or secondary to other lesion ie valves/VSD

Inherited
• Toxins: eg alcohol, catecholamines
(phaeochromocytoma or stress
cardiomyopathy (takosubo’s
cardiomyopathy)
• Viral: acute myocarditis or chronic
DCM
• Other infective: HIV, chaga’s
disease, Lyme’s disease.......
• End stage hypertrophic
cardiomyopathy
• End stage arrhythmogenic RV
cardiomyopathy
• Systemic disease: sarcoidosis,
haemachromatosis, SLE,
mitochondrial dis.
• Muscular dystrophies
• Peri-partum cardiomyopathy
• Hypertension
• Isolated non compaction
• Tachycardia related
cardiomyopathy
• RV pacing induced
cardiomyopathy
20
Q

How do you figure out which type of heart failure is present? Ischaemic heart disease (IHD), valvular disease or dilated cardiomyopathy

A

take a detailed history
ECG, CXR, always do an echo
Most patients should be assessed by a cardiologist

21
Q

why is echocardiography such an essential investigation?

A

gives images of the heart
it enables you to identify and severity of heart problem:-
• LV systolic dysfunction
• Valvular dysfunction
• Pericardial effusion / tamponade
• Diastolic dysfunction
• LVH
• Atrial/ventricular shunts / complex congenital heart
defects
• Pulmonary hypertension / Right heart dysfunction

May not identify constriction / may miss shunts
(but you will see atrial dilatation)

22
Q

what is the LV ejection fraction

A

the amount of blood that actually gets pumped out by the LV during systole as a % of the total blood in the LV

23
Q

what can change the LVEF?

A

Disease / physiological changes can both decrease and increase the LVEF - it is however a continuous biological variable like haemoglobin / anaemia

24
Q

why can it be very difficult to quantify the LVEF accurately

and reproducibly by echo?

A

Quality of images
Experience of operator

Calculation method of LVEF – M-mode, Simpson’s biplane

Use of contrast agents
Time-consuming to perform accurately
Normal range is centre specific, but LVEF not routinely
measured and NR not routinely established

25
Q

Normal value for ejection fraction?

A

50-80%

26
Q

value for mild ejection fraction

A

40-50%

27
Q

moderate ejection fraction value

A

30-40%

28
Q

severe ejection fraction value?

A

<30%

29
Q

what is a MUGA scan?

A

scan using ionising radiation to help measure LVEF
Pros:-
It is much easier to obtain an accurate LVEF
greater reproducibility

cons:-
ionising radiation
no additional info about structure of the heart

30
Q

what is the gold standard investigation for LVEF

A

MRI scan

31
Q

pros and cons for MRI scan to investigate LVEF?

A 
Pros:- 
Greater reproducibility
normal range
Added information about
Can see cause of LV problem such as
• Fibrosis
• Infiltration
• Oedema
Can see heart valves
Cons:- 
Time consuming – Approx 1
hour
Patient compliance
Long breath holds
Claustrophobic
Ability to lie flat
Specialist centres
Long waiting lists
32
Q

class 1 and 4 of NYHA classification of heart failure?

A

class 1 - no limitation on exercise tolerance, symptoms- no symptoms during usual activity

class 4 - severe limitation, symptoms - any physical activity brings on discomfort and symptoms occur at rest

33
Q

treatment/therapy for heart failure due to LV systolic dysfunction

A

diuretics
ACE inhibitors/ ARBs (Angiotensin II receptor blockers)
Beta blockers - carvedilol/bisoprolol
Aldosterone receptor blockers
ARNI’s (angiotensin receptor-neprilysin inhibitor)

34
Q

Give 1 example of ARNI’s medication?

A

Entresto

35
Q

Give 4 examples of ACE inhibitors/ ARBs (Angiotensin II receptor blockers)

A

Ramipril
enalapril
candesartan
valsartan

36
Q

give 2 examples/types of diuretic medication used for heart failure?

A

furosemide

bumetanide

37
Q

Why does cardiac output not mean heart failure?

A

because someone can have a higher cardiac output than a normal person due to for example LV dilatation and yet this person could have severe heart failure

1ST YEAR SYSTEMS: Cardiovascular (39 decks)

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