CVS 10 Heart Failure - Investiagtions + Management Flashcards
Describe Class I heart failure
No symptomatic limitation of physical activity
Describe Class II heart failure
Slight limitation of physical activity
Ordinary physical activity results in symptoms
No symptoms at rest
Describe Class III heart failure
- Marked limitation of physical activity
- Less than ordinary physical activity results in symptoms
- No symptoms at rest
Describe Class IV heart failure
- Inability to carry out physical activity without symptoms
- May have symptoms at rest
- Discomfort increases with any degree of physical activity
Key points for investigating heart failure
- history, clinical examination, investigations
- type of heart failure - HFrEF, HFpEF, LV/RV, high output cardiac failure
- cause of heart failure - IHD, hypertension etc.
Types of management of heart failure
- Symptomatic treatment - furosemide
- Prognostic treatment - HFrEF only
Prognositic treatment of heart failure
- cardiac rehabilitation
- ACE inhibitors/AngII receptor blockers
- Beta blockers
- Mineralcorticoid receptor antagonist e.g. spironolactone
- Sacubitril valsartan, SGLT2 inhibitors
- Biventricular pacemaker or defibrillator
Effect of IV furosemide
Venodilatory effect immediately
Onset diuretic action 30 mins, peaks 60-90mins - decreases circulating volume > decreases afterload > increases CO
Monitoring of IV furosemide
HR
BP
CXR
pO2
U&Es
Fluid balance
Hourly urine output
Daily weights - 1kg loss per day aim
Effects of beta blockers
Decrease HR
Decrease BP - reduced CO > lower O2 demand
Reduced mobilisation of glycogen
Negate unwanted effects of catecholamines
Investigations for heart failure
Echocardiogram (gold standard)
FBC - check for anaemia
U+E
Brain natriuretic peptide
ECG
Chest X ray
Coronary angiography
Why do you want to check for anaemia on a FBC in relation to heart failure?
Anaemia can worsen heart failure
Increased work of heart to meet O2 demand
What is brain natriuretic peptide produced by?
Stretching of ventricles
To try reduce BP by increasing Na + fluid loss
What does an elevated brain natriuretic peptide level suggest?
Heart failure
Aim of pharmacological therapy of chronic heat failure
Reduced afterload
Increase CO
What is the best way to diagnose pulmonary oedema?
Chest X ray
Patient presents with symptoms of heart failure at rest, what classification of heart failure is this?
Class IV
Non pharmacological treatment of chronic heart failure
- reduce salt + liquid intake
- avoid salt substitutes
- reduce alcohol
- smoking cessation
What is the mechanism of action of Sacubitril?
What drug is it often co prescribed with?
- neprilysin inhibition
- inhibitors natriuretic inactivating enzyme > increases effects of ANP/BNP > natriueiss
- stops bradykinin breakdown > vasodilation
. - valsartan (ARB)
What addition meds can be given is first line treatment of heart failure isn’t successful
- SGLT2 inhibitors e.g. dapaglifozin
- Sacubitril valsartan
- ivabradine
- digoxin
- hydralazine + nitrate (especially if Afro-Caribbean)
What bloods are needed for investigating heart failure?
- renal function
- FBC
- LFT’s
- TFT’s
- ferritin + transferrin
- BNP
Possible findings on a CXR in heart failure
- cardiomegaly
- pleural effusions
- perihilar shadowing/consolidations
- alveolar oedema
- air bronchograms
- increased width of vascular pedicles
Pharmacological management of heart failure
- diuretics e.g. furosemide
- ACE inhibitor e.g. ramipril
- beta blocker e.g. bisoprolol
- aldosterone antagonist e.g. spironolactone or eplerenone
- monitor U&Es
What is the action of BNP?
- Relaxes vascular smooth muscle > reduces systemic vascular resistance
- promotes water excretion by kidneys > reduced circulating volume
Management of acute left ventricular failure
- sit up
- O2
- diuretics
- stop IV fluids
- identify underlying cause
- monitor fluid balance
- inotropes + vasopressors if needed
