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CARDIOLOGY > CONGESTIVE HEART FAILURE > Flashcards

CONGESTIVE HEART FAILURE Flashcards

1
Q

What is Congestive Heart Failure? And what does Congestive refer to?

A

Chronic progressive condition affecting the hearts ability to effectively pump blood

Congestive - refers to the buildup of fluid around the heart

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2
Q

What are the two main types of Heart Failure?

A

Left-Sided Heart Failure where the left ventricle’s damaged myocardium causes build up of fluid i the lungs

Right-sided Heart Failure where the right ventricle has difficulting pumping blood into the lungs leading to peripheral fluid retention

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3
Q

Which is the most common heart failure?

A

Left-Sided heart failure?

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4
Q

What are the two different types of Left-Sided Heart Failure?

A

Systolic - inability to contract, reducing force available to push blood into circulation(EF <40%)

Diastolic - stiffening of ventricular muscles prevents adequate filling, reducing volume pumped out of the heart

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5
Q

What is the main conditions that lead to Heart Failure?

A

CAD - most common; leads to reduced blood flow to heart > Ischaemia

Hypertension - increases workload > muscle stiffens

Faulty Heart Valves - increase workload > weaken heart

Cardiomyopathy - damaged muscle due to infection, drugs, alcohol abuse, genetics

Heart Arrhythmia - increase work on the heart

Eisenmenger Syndrome - pulmonary hypertension causes flow of deoxygenated blood from right to left ventricle via a lesion > cyanosis

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6
Q

What are the symptoms of congestive heart failure?

A

Orthopnoea

dyspnoea when exercising

Chronic cough and wheezing

Chest discomfort

Rapid weight gain

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7
Q

What types of physical signs will show in Heart Failure?

A

low extremities oedema

Ascites

Rales

Rapid and Irregular heart beat

High Blood Pressure

Positive Hepatojugular Reflux (JVP >3cm)

S3 gallop

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8
Q

What causes an S3 Gallop in heart failure?

A

Overly dilated LV in systolic HF causes a gallop when blood flows through mitral valve

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9
Q

What are the risk factors of a Heart Failure?

A

Male

> 65

FH of Heart Failure

Cocaine Users

Hypertension

Atrial Fibrillation

Thyroroxicosis and hypothyroidism

MI

Diabetes

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10
Q

What are the differentials of Heart Failure?

A

COPD/Pulmonary Fibrosis

Pneumonia

Pulmonary Embolism

Pericardial Disease

DVT

(Read up on differentiating factors)

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11
Q

What will you see on a Echocardiogram for Heart Failure?

A

Normal if diastolic LV Heart Failure

<40% systolic LV Heart Failure

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12
Q

What Blood Tests would you order in Heart Failure?

A

FBC: to look for anaemia and high lymphocytes

U&E: rules out renal disease; hyponatremia and hypokalemia and hypomagnesemia

ABG: metabolic alkalosis +/- respiratory alkalosis

LFT: elevated in abdominal congestion

TFT: test for thyroid disease

BNP: elevated

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13
Q

What does a Heart Failure CXR show?

A

Sign of pulmonary oedema

Cardiomegaly

Transudative Pleural Effusion

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14
Q

What does ECG show in Heart Failure?

A

Duration of QRS >120ms

Pathological Q wave (shows old Acute MI)

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15
Q

What does SAW-PANIC stand for?

A

It is a major diagnostic criteria for HF

S3 gallop

Acute pulmonary Oedema

Weigh Loss

Paroxysmal nocturnal Dyspnoea

Abdominojugular reflex

Neck vein Distended (JVP)

Increased cardiac shadow on CXR

Crackled Lung Sound

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16
Q

What is HEART-VINO?

A

Minor diagnostic criteria for heart failure

Hepatomegaly

Effusion, pleural

Ankle oedema

exeRtional dyspnoea

Tachycardia

Vital capacity decreased by 1/3

Nocturnal cough

17
Q

How many major or minor diagnostic criteria are needed in Heart Failure?

A

2 major or 1 major and 2 minors

18
Q

What is the first line HF treatment?

A

Captopril or Ramopril

ACE INHIBITORS - inhibit LV hypertrophy and vasoconstriction, decrease water and salt retention

19
Q

What do you use if there is ACEi intolerance?

A

Bisoprolol/Metoprolol + Candesartan/Losartan

20
Q

What is Sacubitril-Valsartan? What are the side effect?

A

Combination therapy of a vasodilator and an ARB for Heart Failure

Side Effects = anaemia, cough, electrolyte imbalance, hypoglycaemia

21
Q

You’ve used the ACEi and Beta Blocker but symptoms and reduced EF persists.

What’s your next option?

A

Give Eplerenone or Spironolactone

Aldosterone Receptor Antagonist

Stops reabsorption of sodium > encourages water loss > decreases blood pressure and fluid buildup

22
Q

When is a Loop Diuretic used?

Which one is used?

How does it work?

A

If patient has evidence or history of fluid retention

Furosemide or Bumetanide
Used with ACEi and Beta Blocker

Promote salt and water removal - reduce retention

23
Q

What medication is given to patients with heart rhythm abnormalities in Heart Failure?

A

Digoxin

It inhibits ATPase > allows movement of calcium, sodium and potassium into heart muscles > Strengthens heart muscle contraction

AV node inhibition > slows heart rate

24
Q

What are the side effects of Digoxin?

A

Arrhythmia, Diarrhoea, Dizziness

25
Q

What lifestyle changes can be done to help in Heart Failure?

A

Moderate Aerobic Exercise

Avoid salt, added sugars, solid fats and refined grains

Watch your weight

Avoid or quit drinking too much alcohol and smoking tobacco

26
Q

Define the following surgical procedure: Coronary Bypass

A

Bypasses blocked artery in the heart to provide effective blood flow

27
Q

Define the following surgical procedure: Heart Valve Repair/Replacement

A

Allows valves to close righty and eliminate backward flow of blood

28
Q

Define the following surgical procedure: ICDs

A

Implantable Cardioverter Difibrillator

Similar to pacemaker, used to monitor and modulate heart rhythm

29
Q

Define the following surgical procedure: CRT

A

Biventricular pacemaker used to improve effectiveness and coordination of ventricular pumping

30
Q

What are some complications of HF?

A

Liver Damage

Kidney Damage

Anaemia

Heart Valve Problems

CARDIOLOGY (8 decks)

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