Chronic heart failure (zero to finals) Flashcards
What is chronic heart failure?
Refers to the clinical features of impaired heart function, specifically the function of the left ventricle to pump blood to the rest of the body.
How does pulmonary oedema occur in heart failure?
Impaired left ventricular function results in a chronic backlog of blood waiting to flow into and through the left side of the heart.
The left atrium, pulmonary veins and lungs experience an increased volume and pressure of blood.
They start to leak fluid and cannot reabsorb excess fluid from the surrounding tissues, resulting in pulmonary oedema.
What is the ejection fraction?
The percentage of blood in the left ventricle squeezed out with each ventricular contraction. An ejection fraction above 50% is considered normal.
What is heart failure with reduced ejection fraction?
When the ejection fraction is less than 50%.
What is heart failure with preserved ejection fraction?
When someone has the clinical features of heart failure but an ejection fraction greater than 50%.
This is the result of diastolic dysfunction, where there is an issue with the left ventricle filling with blood during diastole (the ventricle relaxing).
Causes of chronic heart failure?
Ischaemic heart disease
Valvular heart disease (commonly aortic stenosis)
Hypertension
Arrhythmias (commonly atrial fibrillation)
Cardiomyopathy
What are the key symptoms of chronic heart failure?
Breathlessness, worsened by exertion
Cough, which may produce frothy white/pink sputum
Orthopnoea, which is breathlessness when lying flat, relieved by sitting or standing (ask how many pillows they use)
Paroxysmal nocturnal dyspnoea (more detail below)
Peripheral oedema
Fatigue
Examination findings in chronic heart failure?
Tachycardia (raised heart rate)
Tachypnoea (raised respiratory rate)
Hypertension
Murmurs on auscultation indicating valvular heart disease
3rd heart sound on auscultation
Bilateral basal crackles (sounding “wet”) on auscultation of the lungs, indicating pulmonary oedema
Raised jugular venous pressure (JVP), caused by a backlog on the right side of the heart, leading to an engorged
internal jugular vein in the neck
Peripheral oedema of the ankles, legs and sacrum
What is paroxysmal nocturnal dyspnoea?
Paroxysmal nocturnal dyspnoea (PND) describes the experience that patients have of suddenly waking at night with a severe attack of shortness of breath, cough and wheeze.
What assessments are used for diagnosing heart failure?
Clinical assessment (history and examination)
N-terminal pro-B-type natriuretic peptide (NT‑proBNP) blood test
ECG
Echocardiogram
What is NT-proBNP test?
NT-proBNP levels in the blood are used are used for screening and diagnosis of congestive heart failure and can also be used to establish prognosis
What other investigations can be done for heart failure?
Bloods for anaemia, renal function, thyroid function, liver function, lipids and diabetes
Chest x-ray and lung function tests to exclude lung pathology
What are the 5 principle management options of chronic heart failure (RAMPS)?
R – Refer to cardiology
A – Advise them about the condition
M – Medical treatment
P – Procedural or surgical interventions
S – Specialist heart failure MDT input, such as the heart failure specialist nurses, for advice and support
What is the medical treatment of chronic heart failure (ABAL)?
A – ACE inhibitor (e.g., ramipril) titrated as high as tolerated
B – Beta blocker (e.g., bisoprolol) titrated as high as tolerated
A – Aldosterone antagonist when symptoms are not controlled with A and B (e.g., spironolactone or eplerenone)
L – Loop diuretics (e.g., furosemide or bumetanide)
If ACE inhibitors are not tolerated, what can be used as an alternative in heart failure?
ARB’s (angiotensin receptor blockers) such as candesartan
