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Cardiovascular system > chronic heart failure- epidemiolgy. investigation and diagnosis > Flashcards

chronic heart failure- epidemiolgy. investigation and diagnosis Flashcards

1
Q

what is the definition of 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

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2
Q

what is the prognosis of heart failure?

A

30-40% mortality at 1 year

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3
Q

what are the factors that are contributing to the increase in prevalence of heart failure?

A
  • treatment of acute myocardial infarction. past MI increases risk of CHF
  • aging population
  • increased incidence and prevalence of: ypertension, CHD, obesity, diabetes, high cholesterol
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4
Q

what are the symptoms of congestive heart failure?

A
  • dyspnoea
  • fatigue
  • oedema
  • reduced exercise capacity
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5
Q

what are the signs of congestive heart failure

A
  • oedema
  • tachycardia
  • raised JVP
  • chest crepitations or -effusions
  • 3rd heart beat
  • displaced or abnormal apex beat
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6
Q

what are the 2/3 the two criteria for heart failure to be diagnosed?

A
  1. Symptoms or signs of HF (rest or exercise)
    and
  2. Objective evidence of cardiac dysfunction
    and (in doubtful cases)
  3. Response to therapy (diuretics)
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7
Q

what are the investigations carried out (to obtain objective evidence of cardiac dysfunction) for heart failure?

A
  • ECHO
  • Radionucleotide Scan
  • Left Ventriculogram
  • Cardiac MRI
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8
Q

what are the 2 investigations that can be carried out for screening for congestive heart failure?

A

12 lead ECG-entirely normal to rule out heart failure

brain natriuretic peptide-elevated in heart failure

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9
Q

what does raised brain natiuretic peptide indicate?

A

heart failure or left ventricular systolic dilatation. and indicates the need for echo/cardiac assessment

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10
Q

what is the order of investigations and examination for the for the diagnosis of heart failure

A
  1. symptoms of signs suggest CHF
  2. FBC. fasting blood glucose. serum urea and electrolytes, urinalysis, thyroid function and chest x-ray
  3. BNP and ECG
  4. if BNP elevated or ECG abnormal
  5. refer for echocardiography
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11
Q

what are the structural causes of 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

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12
Q

what is the main causes of left ventricular systolic dysfunction?

A

-Ischaemic heart disease (usually MI)
- Severe AV disesase or MR
-Dilated cardiomyopathy(DCM): Means LVSD not due to IHD or
secondary to other lesion ie valves/VSD
-hypertension

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13
Q

what are the ways to diagnose LVSD?

A 
1. take detailed history
look for: MI, DI, HBP, post partum, alcohol
2. ECG
3. CXR
4. ECHO
5. coronary angigraphy (if chest pain. <70)
6. CT coronary angiography 
7. cardiac MRI
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14
Q

what is echocardiography used to determine in CHF?

A 
•Identify and quantify
• LV systolic dysfunction
• Valvular dysfunction
• Pericardial effusion / tamponade
• Diastolic dysfunction
• LVH
• Atrial/ventricular shunts / complex congenital heart
defects
• Pulmonary hypertension / Right heart dysfunction
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15
Q

what is a normal LV ejection fraction?

A

50-80%

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16
Q

what is the ejection fraction for mild cardiac failure?

A

40-50%

17
Q

hat is the ejection fraction for moderate cardiac failure?

A

30-40%

18
Q

What is the ejection fraction for severe cardiac failure?

A

<30%

19
Q

what are the investigations done to assess LVEF?

A

echocardiogram
MUGA
cardiac MRI -gold standard

20
Q

what are the pros and cons of MUGA over echocardiography for measuring LVEF?

A 
pros
Much easier to obtain an accurate figure for the
LVEF
•Greater reproducibility
• centre specific normal range

cons
•Ionising radiation
•No additional structural information

21
Q

what are the pros and of using cardiac MRI to determine LVEF?

A 
pros
• Greater reproducibility
• normal range
• Added information about
Aetiology
- Fibrosis
- Infiltration
- Oedema
•  can assess valves
cons
• Time consuming – Approx 1
hour
• Patient compliance
• Long breath holds
• Claustrophobic
• Ability to lie flat
• Specialist centres
• Long waiting lists
22
Q

what is the new york association classification of heart failure (NYHA) class 1

A

exercise tolerance-no limitation

symptoms- no symptoms during usual activity

23
Q

what is the new york association classification of heart failure (NYHA) class 2

A

exercise-mild limitation

symptoms-comfortable with rest or with mild exertion

24
Q

what is the new york association classification of heart failure (NYHA) class 3

A

exercise- moderate limitation

symptoms- comfortable only at rest

25
Q

what is the new york association classification of heart failure (NYHA) class 4

A

exercise- severe limitation

symptoms- any physical activity brings on discomfort and symptoms occur at rest

26
Q

how does prognosis vary with increasing NYHA class?

A

it decreases

27
Q

is cardiac output reduced by heart failure?

A

no

28
Q

what are the treatments for heart failure?

A 
diuretics
ACEi/ARBs
beta blockers
aldosterone receptor blockers
ARNIs
29
Q

which diuretics are used to treat heart failure?

A

Furosemide/Bumetanide

for Symptomatic relief

30
Q

which ACEi/ARBs are used for heart failure

A

ACEI-Ramipril, enalapril

ARBs- Candesartan/valsartan

31
Q

which beta blockers are used to treat heart failure?

A

Carvedilol/Bisoprolol

32
Q

which aldosterone receptor blockers are used to treat heart failure?

A

Spironolactone/Eplerenone

33
Q

which ARNIs are used to treat heart failure?

A

Entresto

Cardiovascular system (40 decks)

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