Chronic Heart Failure Flashcards
What is systolic heart failure? [1]
Impaired left ventricular contraction.
What is diastolic failure? [1]
Impaired left ventricular relaxation.
What is orthopnoea? [1]
Shortness of breath when lying flat.
What is paroxysmal nocturnal dyspneoa (PND)? [1]
When a patient wakes up suddenly at night with severe attack of shortness of breath and cough.
What mechanisms cause PND? [3]
1) Fluid settling across a large surface area of their lungs as they sleep lying flat.
2) The brain becomes less responsive in sleep, so less responsive to reduced Oxygen saturations. Therefore person develops more significant pulmonary congestion and hypoxia.
3) Less adrenaline circulating during sleep, so mycardium is more relaxed and thus reduced cardiac output.
How do you diagnose chronic heart failure? [4]
- Clinical presentations (PND etc.)
- Echocardiogram
- ECG
- BNP blood test
What specifc BNP test is diagnostic for Chronic Heart Failure? [1]
NT-proBNP
(N-Terminal pro-B-type natriuretic peptide)
What are the main causes for Chronic Heart Failure? [4]
- Ischaemic Heart Disease
- Hypertension
- Valvular Heart Disease (aortic stenosis)
- Arrythmias (atrial fibrillation)
What are the NICE 2018 guidelines for management of chronic heart failure? [5]
- Specialist Referral
- Explanation of condition to patient
- Medical mgmt.
- Surgical mgmt. (aortic stenosis / mitral regurg.)
- HF specialist nurse for advice and support
What NT-proBNP level necissitates urgent specialist referral? [1]
NT-proBNP > 2,000 ng/litre
What are some advices you can give to a patient with chronic heart failure? [4]
- smoking cessation
- excercise as tolerated
- flu vaccine
- optimise treatment of co-morbidities
What is the first line medical treatment for chronic heart failure? [4]
A B A L
- ACE Inhibitor
- Beta Blocker
- Aldosterone Agonist
- Loop diuretics (symptoms)
What ACE inhibitor is used for Chronic Heart Failure? At what dose? [2]
Ramipril
up to 10mg once daily
What beta blocker is used for Chronic Heart Failure? At what dose? [2]
Bisoprolol
up to 10mg once daily
Whataldosterone antagonist is used for Chronic Heart Failure? At what dose? [2]
Spironolactone or Eplerenone
if symptoms not controlled with A and B
