CVD Flashcards
Heart failure
case 1
Heart failure
New York Heart Association (NYHA)?
Table 1. New York Heart Association functional classification of heart failure
Class
Symptoms
Class I (mild)
No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, dyspnoea or palpitations (asymptomatic LV dysfunction).
Class II (mild)
Slight limitation of physical activity. Ordinary physical activity results in fatigue, dyspnoea, angina or palpitations.
Class III (moderate)
Marked limitation of activity. Less than ordinary physical activity leads to symptoms.
Class IV (severe)
Severely limited by symptoms. Symptoms present at rest.
Inv
ECG, CXRAY, ECHO, BNP - B-type natriuretic peptide (BNP) is not recommended for diagnosis of chronic heart failure; BNP level (<100 ng/L) makes the diagnosis of heart failure unlikely
Rx
ACEIs) are first-line treatment for heart failure of any class. They should be commenced immediately, at a low dose, with the view to titrating the dose over intervals (e.g. 2–4 weeks) to maximally tolerated maintenance doses as per current guidelines.
non- pharmacological management strategies for patients.
sodium (<2 g/day) and fluid (<2 L/day) is recommended. A lower fluid intake (<1.5 L/day) is advised for patients during episodes of fluid retention
Patients can monitor their fluid status by measuring their morning weight before breakfast.
regular physical activity is advised to improve symptoms and functional capacity
quitting smoking; limiting alcohol to less than 1–2 standard drinks per day and limiting caffeinated beverages to 1–2 drinks per day
Dietary assessment
vaccination against influenza and pneumococcal disease
non- pharmacological management strategies for patients.
sodium (<2 g/day) and fluid (<2 L/day) is recommended. A lower fluid intake (<1.5 L/day) is advised for patients during episodes of fluid retention
Patients can monitor their fluid status by measuring their morning weight before breakfast.
regular physical activity is advised to improve symptoms and functional capacity
quitting smoking; limiting alcohol to less than 1–2 standard drinks per day and limiting caffeinated beverages to 1–2 drinks per day
Dietary assessment
vaccination against influenza and pneumococcal disease
Pharmo
ACEIs; heart failure beta-blockers (carvedilol, bisoprolol, metroprolol succinate, nebivolol; MRA (i.e. spironolactone or eplerenone) prolong survival
Start low and go slow
MRA- initiated if K+ and renal functions are normal. contraindicated if the creatinine clearance (CrCl) is <30 mL/min of if the serum potassium is >5.5 mmol/L; Monitoring of potassium and renal function closely
Others
Ivabradine is a specific sinus node inhibitor, which inhibits the sinoatrial ‘pacemaker’
implantable cardioverter defibrillators have been shown to further decrease mortality
case 2
AF
causes
hypertension, mitral valve disease, hyperthyroidism, ischaemic heart disease,
heart failure, sleep apnoea, excess alcohol and/or caffeine consumption, and smoking status (including marijuana
Inv
complete blood count to identify underlying conditions (e.g. anaemia, infection), metabolic profile, echocardiography, ECG and cxray
AF has been associated with…..
5-fold increase in the risk of stroke and a 3-fold increase in the risk of heart failure
Assessment
- Patient assessment
- Risk mitigation
- Anticoagulant selection.
- Non-valvular AF patient assessment – CHADS 2 score calculator
Table 1. CHADS2 tool for estimation of thromboembolic risk in people with non-valvular AF
Risk factor
Score
Congestive heart failure 1
Hypertension (including well controlled hypertension) 1
Age 75 years or older 1
Diabetes mellitus 1
Stroke or history of transient ischaemic attack (TIA) 2
Oral anticoagulation treatment is recommended for …….
for those deemd to have a moderate-to-high risk of stroke (i.e. CHADS2 score ≥1
The evidence for aspirin (an antiplatelet agent) in stroke prevention in AF is weak
