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Yr3 CARDIOVASCULAR > Condition- Heart Failure > Flashcards

Condition- Heart Failure Flashcards

1
Q

What two systems are chronically activated in Chronic HF to help maintain arterial pressure and cardiac output?

A

RAAS and the SNS

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2
Q

Define acute HF

A

Rapid onset new HF/ decompensation of chronic heart failure leading to pulmonary and peripheral oedema +/- peripheral hypoperfusion

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3
Q

List some causes of Low CO Chronic LHF

A
  1. Valvular Pathology
    • Aortic Stenosis
    • Aortic Regurg
    • Mitral Regurg
  2. Heart Muscle pathology
    • IHD
    • Cardiomyopathy
    • Myocarditis
    • Arrythmias (AF)
  3. Systemic Pathology
    • HT
    • Amyloidosis
    • Drugs (alcohol, cocaine, BBs)
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4
Q

List some causes of Low CO Chronic RHF

A
  1. LHF (CCF)
  2. LUNGS
    • Pulmonary HTN => cor pulmonale
    • PE
    • Chronic Lung disease (Pulmonary fibrosis, interstial lung disease)
  3. VALVULAR PATHOLOGY
    • Tricuspid Regurg
    • Pulmonary Valve disease
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5
Q

List some causes of High output Chronic HF

A

NAP MEALS

  • Nutritional Deficiencies (B1)
  • Anaemia
  • Pregnancy
  • Malignancy (multiple myeloma)
  • Endocrine (hyperthyroidism)
  • AV malformation
  • Liver Cirrhosis
  • Sepsis
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6
Q

List some symptoms of LHF

A

Symptoms due to pulmonary congesition

  • SOBEO, orthopnoea, PND
  • Fatigue
  • Nocturnal pink frothy sputum
  • Wheeze (cardiac wheeze)
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7
Q

List some symptoms of RHF

A

Symtoms due to peripheral fluid accumulation

  • Swelling of face, ankle, ascites
  • Fatigue, anorexia, nausea
  • decreased exercise tolerance
  • Nocturia (BNP release esp when lying down)
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8
Q

List some signs of LHF on examination

A
  • High HR, RR
  • AF or Pulsus alternans
  • Displaced apex beat (dilational CM)
  • S3 gallop, S4 if severe HF
  • Murmurs (AS, AR, MR)
  • Lungs:
    • Fine-end inspiratory crackles (pulmonary oedema)
    • Wheeze (cardiac wheeze)
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9
Q

What sign might you feel on taking the pulse of someone with LHF?

A

Pulsus Alternans

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10
Q

List some signs of RHF on examination

A
  • Face: swelling
  • Neck: elevated JVP
  • Heart/ Chest: TR murmur, high HR, high RR
  • Abdomen: Ascites, hepatomegaly
  • Othre: pitting oedema (sacral. pedal)
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11
Q

List some investigations you would do on somone with HF

A
  • Bedside: ECG
  • Bloods: FBC, U+Es, LFT, TFT, BNP
  • Imaging: CXR, TTE
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12
Q

What is BNP?

A

Brain Natriueretic Peptide

  • Release when cardiac muscle is stretched
  • Causes renal natriuresis => increased H2O loss
  • Decreased volume of blood and stretching of the cardiac muscle
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13
Q

How is BNP used in the management of someone with HF?

A

BNP = sensitive but not specific (elevated in COPD, IPD etc)

  • High BNP => go on to do TTE
  • Low BNP => if ECG is normal as well HF is unlikely
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14
Q

What might you see on a CXR of someone with HF?

A

ABCDE

  • Alveolar Oedema (Bat wing opacities)
  • Kerley B line (interstitial oedema)
  • Cardiomegaly (>50%)
  • Dilated Upper Lobe Vessels (Pulmonary HTN)
  • Pleural Effusion (pleural, transudative)
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15
Q

Which investigation is diagnostic of HF?

A

TTE (transthoracic echocardiogram coupled with Doppler US)

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16
Q

Which Criteria is used to clinically diagnose Chronic HF?

A

Framingham Criteria

2 Major or 1 Major + 2 minor

17
Q

What might you see on a TTE

A
  1. Can see cause of HF (MI, Valvular disease)
  2. Can calculate Ejection Fracation
18
Q

What is the ejection fraction? What is the normal range?

A

% of volume of blood present in the left ventricle which is pumped out during systole

50-70% is normal

19
Q

What is HFrEF?

A

Heart Failure with reduced Ejection Fraction

Where EF < 40%

Caused by inability of ventricles to contract normally

20
Q

What is HFpRF?

A

Heart Failure with preserved Ejection Fraction

Where EF > 50%

Caused by inability of ventricles to relax and fill properly

21
Q

Go through the management of chronic HF

A

ABCD2

  • ACEi (enalipril): counteracts RAAS activation in chonic HF. All pts with LVF
  • Beta-Blockers (carvedilol): counteracts SNS activation in chronic HF- synergistic with ACEi
  • Treat the Cause + Exacerbation
  • Diuretic (loop-furosemide): if evidence of fluid retention
    • If ARB used (spironolcatone) monitor K+ to prevent hyper K+
  • Digoxin: Positive inotrope (increases contractility)
  • Other: cardiac resynchronisation if LVEF < 35%, may need ICD
22
Q

List some causes of decompensation of Chronic HF

A
  • IHD- MI
  • Arrhythmias
  • Infection
  • Hypo/hyperthyroidism
  • Uncontrolled hypertension
23
Q

Go through the management of someone with Acute HF

A
  • IV access
  • Position upright
  • O2- high flow non-rebreather mask aim for SaO2 of 94-98%
  • Diuretics- IV furosemide
  • Morphine (PRN)
  • Anti-emetic (PRN)
  • Nitates- GTN infusion if Pulmonary Oedema + SBP > 90mmHg
  • Positive Inotropes + CPAP if cardiogenic shock and SBP < 90mmHg
  • Treat the cause + Continuous Monitoring!!!

Yr3 CARDIOVASCULAR (34 decks)

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