CONGESTIVE HEART FAILURE Flashcards
What is Congestive Heart Failure? And what does Congestive refer to?
Chronic progressive condition affecting the hearts ability to effectively pump blood
Congestive - refers to the buildup of fluid around the heart
What are the two main types of Heart Failure?
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
Which is the most common heart failure?
Left-Sided heart failure?
What are the two different types of Left-Sided Heart Failure?
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
What is the main conditions that lead to Heart Failure?
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
What are the symptoms of congestive heart failure?
Orthopnoea
dyspnoea when exercising
Chronic cough and wheezing
Chest discomfort
Rapid weight gain
What types of physical signs will show in Heart Failure?
low extremities oedema
Ascites
Rales
Rapid and Irregular heart beat
High Blood Pressure
Positive Hepatojugular Reflux (JVP >3cm)
S3 gallop
What causes an S3 Gallop in heart failure?
Overly dilated LV in systolic HF causes a gallop when blood flows through mitral valve
What are the risk factors of a Heart Failure?
Male
> 65
FH of Heart Failure
Cocaine Users
Hypertension
Atrial Fibrillation
Thyroroxicosis and hypothyroidism
MI
Diabetes
What are the differentials of Heart Failure?
COPD/Pulmonary Fibrosis
Pneumonia
Pulmonary Embolism
Pericardial Disease
DVT
(Read up on differentiating factors)
What will you see on a Echocardiogram for Heart Failure?
Normal if diastolic LV Heart Failure
<40% systolic LV Heart Failure
What Blood Tests would you order in Heart Failure?
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
What does a Heart Failure CXR show?
Sign of pulmonary oedema
Cardiomegaly
Transudative Pleural Effusion
What does ECG show in Heart Failure?
Duration of QRS >120ms
Pathological Q wave (shows old Acute MI)
What does SAW-PANIC stand for?
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
What is HEART-VINO?
Minor diagnostic criteria for heart failure
Hepatomegaly
Effusion, pleural
Ankle oedema
exeRtional dyspnoea
Tachycardia
Vital capacity decreased by 1/3
Nocturnal cough
How many major or minor diagnostic criteria are needed in Heart Failure?
2 major or 1 major and 2 minors
What is the first line HF treatment?
Captopril or Ramopril
ACE INHIBITORS - inhibit LV hypertrophy and vasoconstriction, decrease water and salt retention
What do you use if there is ACEi intolerance?
Bisoprolol/Metoprolol + Candesartan/Losartan
What is Sacubitril-Valsartan? What are the side effect?
Combination therapy of a vasodilator and an ARB for Heart Failure
Side Effects = anaemia, cough, electrolyte imbalance, hypoglycaemia
You’ve used the ACEi and Beta Blocker but symptoms and reduced EF persists.
What’s your next option?
Give Eplerenone or Spironolactone
Aldosterone Receptor Antagonist
Stops reabsorption of sodium > encourages water loss > decreases blood pressure and fluid buildup
When is a Loop Diuretic used?
Which one is used?
How does it work?
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
What medication is given to patients with heart rhythm abnormalities in Heart Failure?
Digoxin
It inhibits ATPase > allows movement of calcium, sodium and potassium into heart muscles > Strengthens heart muscle contraction
AV node inhibition > slows heart rate
What are the side effects of Digoxin?
Arrhythmia, Diarrhoea, Dizziness
What lifestyle changes can be done to help in Heart Failure?
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
Define the following surgical procedure: Coronary Bypass
Bypasses blocked artery in the heart to provide effective blood flow
Define the following surgical procedure: Heart Valve Repair/Replacement
Allows valves to close righty and eliminate backward flow of blood
Define the following surgical procedure: ICDs
Implantable Cardioverter Difibrillator
Similar to pacemaker, used to monitor and modulate heart rhythm
Define the following surgical procedure: CRT
Biventricular pacemaker used to improve effectiveness and coordination of ventricular pumping
What are some complications of HF?
Liver Damage
Kidney Damage
Anaemia
Heart Valve Problems
