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Med Year 3 > congestive heart failure > Flashcards

congestive heart failure Flashcards

1
Q

what does cardioversion mean

A

synchronised administration of electric shock using electrodes on someones chest, during R waves

restores normal heart rhythm in people with certain types of arrythmias

also can do medicines: amiodarone for AF and verapamil for SVT

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2
Q

what is the frank starling curve and how does it work in a normal heart

A

relationship between volume of blood in heart rate at end of diastole (EDV or pre-load) and force of contraction of ventricle

if myocardial fibres are stretched by an increased volume of blood, there is an increase in force and velocity of contraction

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3
Q

what happens with a failing heart in terms of the FSC

A

reduced contractility = incr EDV = heart tries to respond by increasing force of contraction

but a greater EDV required and graph shifts right

heart eventually decompensates
SV will decrease with further increases in EDV

increases venous pressure causing fluid to leak out of blood into alveolar interstitial fluid = pulm oedema

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4
Q

what is heart failure

A

complex syndrome that can result from any structural or functional cardiac disorder that impairs ability of the heart to function as a pump to support physiological functions

clinical diagnosis

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5
Q

how do you explain heart failure to a patient

A

your heart cannot cope with pumping the full amount of blood in each heartbeat

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6
Q

what are the causes of heart failure

A

ischaemic heart disease

structural: valvular disease
congenital: inherited cardiomyopathies, ASD

rate: uncontrolled AF, anaemia (high output state)

pulmonary causes: COPD, pulmonary fibrosis etc and primary pulmonary hypertension

alcohol and drugs

pericardial disease

auto-immune disease eg sarcoidosis

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7
Q

what are the symptoms of heart failure?

A
  • breathlessness, on exertion especially
  • peripheral oedema and pulmonary oedema - seen in right and left respectively
  • coughing up pink frothy sputum
  • orthopnea
  • PND
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8
Q

how do you define breathlessness

A

NYHA

1 - no symptoms or limitations to ordinary activity
2 - mild symptoms and slight limitation
3 - marked limitation even in ADL
4 - severe limitates, symptoms at rest

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9
Q

what are the signs of heart failure

A 
PO
raised JVP
pitting oedema 
ascites 
tachycardia 
S3 gallop (third heart sound)
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10
Q

how do you diagnose HF

A

signs and symptoms of typical HF

objective evidence of structural or functional cardiac abnormality at REST, eg cardiomegaly on chest x-ray, S3, echocardiographic abnormalitiy

have to define the cause: heart failure secondary to ……

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11
Q

what investigations do you do for HF

A

bloods: FBC, haematinics (anaemia can be a cause of HF), U&Es, TFT, glc, LFTs

BNP
(polypeptide secreted by ventricles of the heart in response to excessive stretching of heart muscle cells)

normal levels = No HF, 
>400 
chest x-ray for PO, cardiomegaly
ABGs
Troponin for MI 
echocardiography - EF, can show previous MI 
ECGs
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12
Q

what is ejection fraction

A

how much blood the left ventricle pumps out with each contraction as a %

eg EF of 60% = 60% of total amount of blood in the left ventricle is pushed out with each heartbeat

can have HF with preserved LV function, EF >45% or HF with LV systolic dysfunction <45%

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13
Q

what is the management for HF?

A

ABAL:

  1. ace-inhibitors eg ramipril
  2. beta blockers eg bisoprolol
  3. aldosterone antaognists ege spironolactone if symptoms not controlled with A and B
  4. loop diuretics like furosemide to control fluid
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14
Q

how do ACE-I work for HF

A

inhibit LV hypertrophy and remodelling, inhibit vasoconstriction and lowers arterial constriction and increases venous capacities
decreases salt and water retention

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15
Q

which b-blockers are licensed for ACE-I

A

bisoprolol, carvedilol, nebivolol, NOT ATENOLOL

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16
Q

why and when is spironolactone used for HF

A

-aldosterone receptor antagonists

  • treatment when EF <35%, NYHA 2
    anti-fibrotic
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17
Q

what is mechanical desynchrony

A

heart doesn’t contract as one efficient unit

L&R contracts at diff times
LV may contract in segments instead of one unit

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18
Q

What does CRT mean

A

pacemaker

atrial lead, RV lead, LV lead

passed through coronary sinus and into one of the vessels on the outside lateral wall of the heart

19
Q

how does a pacemaker work

A

improve synchronicity between L&R

improves cardiac function

20
Q

what is an implantable cardiac defibrillation device

A

used in patients with EF <35%
detect and treats ventricular arrythmias
failure = ccardiovert

21
Q

what are the guidelines for ACUTE HF: initial

A

key: single BNP, TTE
initial: IV diuretics, bolus or infusion, inotropes (increase the force of cardiac contractions, for example digoxin)

non-invase ventilation without delay if person has cardiogenic PO and severe dyspnea

invasive ventrilation in people with AHF that leads to resp failure

if diuretic resistance: ultrafiltration

22
Q

what is the treatment for Acute HF after stabilisation

A

continue B blockers
start diuretics orally
offer ARB/ACE-I

valvular surgery and PCI

-aortic valve replacement or mitral valve repair

23
Q

when is digoxin used

A

for rate control for AF

or worsening or severe HF with reduced EF despite for heart failure

24
Q

what is AF

A

uncoordinated, rapid contraction of the atria due to disorganised electrical activity

the blood flow will be turbulent = stasis of blood in atria

25
Q

what is the main complication of AF

A

clots to form and risk of stroke&raquo_space;

26
Q

how do you diagnose AF

A

manual palpation of irregularly irregular pulse

ECG: no p waves, tachycardia, irregularly irregular

24-hour ECG if paroxysmal suspected

-echo

27
Q

what is the chads2vasc score

A

stroke risk to assess stroke risk in people with: AF, atrial flutter

28
Q

what is the HAS-BLED score

A

risk of bleeding in people who are starting anti-coagulation

DO NOT offer stroke prevention therapy to people aged under 65 years with Afib and no risk factors other than their sex is female

29
Q

main anti-coagulants?

A

DOAC’s: apixaban, dabigatran, rivaroxaban,

warfarin

30
Q

what is the first line strategy for AF

A

rate control: beta-blocker: bisoprolol, carvedilol
-CCB: diltiazem, verapamil

  • do NOT give if new onset, causing HF, does not have a reversible cause
  • aim for HR <90bpm

DOAC’s

digoxin: monotherapy only acceptable in sedentary patients

31
Q

when can you cardiovert?

A

if AF <48 hours or if >48 hours and on amiodarone 4 weeks before and 12 months after

32
Q

what is pharmacological cardioversion

A

-pharmacological cardioversion: beta blockers, dronedarone, fliconide, amiodarone

33
Q

what is electrical cardioversion

A

shocks cells back into normal sinus rhythm, involves placing electrodes on outside

34
Q

what is parxoysmal AF

A

<7d or episodic

35
Q

managing acute, new onset AF?

A

offer heparin immediately and if patient has signs of haemodynamic instability, perform emergency cardioversion

if patient is stable and AF started <48 hours ago, offer rate or rhythm control

for rhythm control: DC cardiovert or flecainide
for rate; bisoprolol or diltiazem

if stable patient and AF >48, offer rate control first:
if rhythm control is chosen, patient must be be anti-coagulated for >3 weeks

36
Q

what is IE

A

rare and potentially fatal infection, caused by bacteria entering blood and settling in endocardium, a heart valve or a blood vessel

37
Q

who is most at risk of IE

A 
heart valve disease
having prosthetic valves 
hypertrophic cardiomyopathy 
injecting 
fungal endocarditis
38
Q

what are the peripheral signs of endocarditis

A 
petechiae 
subungual (splinter) haemorrhages 
osler nodes 
janeway lesions 
roth spots - retinal haemorrhages with small, clear centres, rare and observed in 5% of patients
39
Q

how do you diagnose IE

A

modified duke criteria : requires 2 major criteria, 1 major and 3 minor criteria or 5 minor criteria

40
Q

what is the major criteria for IE

A

positive blood culture IE, evidennce of endocardial involvement
positive echo for IE: intra-cardiac mass on valve or supporting structures, on implanted valve, an abscess, new wound or new regurg

41
Q

what is the minor criteria for IE

A

predisposing heart condition, fever >38
aneurysms, emboli, haemorrhages etc
immunological phenomena: glomerulonephritis, olser’s nodes etc
microbioogical phenomena: positive blood culture but does not meet a major criterion on micro-organisms

PCR
echo

42
Q

what does BCNIE mean

A

IE in which no causative micro-organism can be grown using the usual blood culture methods

can occur in upto 31% of cases of IE

43
Q

what is the management for IE

A

anti-biotics: initially vancomycin or ampicillin, plus an aminoglycoside
IV first then full course orally

surgery for fungal infection, or infection with aggressive anti-biotic resistant bacteria
valve problems

antibiotic prophylaxis for patients with a history of IE undergoing dental or other procedures: amoxocillin or clindamycin

Med Year 3 (25 decks)

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