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CVS > CVS 10 Heart Failure - Investiagtions + Management > Flashcards

CVS 10 Heart Failure - Investiagtions + Management Flashcards

1
Q

Describe Class I heart failure

A

No symptomatic limitation of physical activity

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2
Q

Describe Class II heart failure

A

Slight limitation of physical activity
Ordinary physical activity results in symptoms
No symptoms at rest

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3
Q

Describe Class III heart failure

A
  • Marked limitation of physical activity
  • Less than ordinary physical activity results in symptoms
  • No symptoms at rest
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4
Q

Describe Class IV heart failure

A
  • Inability to carry out physical activity without symptoms
  • May have symptoms at rest
  • Discomfort increases with any degree of physical activity
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5
Q

Key points for investigating heart failure

A
  • history, clinical examination, investigations
  • type of heart failure - HFrEF, HFpEF, LV/RV, high output cardiac failure
  • cause of heart failure - IHD, hypertension etc.
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6
Q

Types of management of heart failure

A
  • Symptomatic treatment - furosemide
  • Prognostic treatment - HFrEF only
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7
Q

Prognositic treatment of heart failure

A
  • cardiac rehabilitation
  • ACE inhibitors/AngII receptor blockers
  • Beta blockers
  • Mineralcorticoid receptor antagonist e.g. spironolactone
  • Sacubitril valsartan, SGLT2 inhibitors
  • Biventricular pacemaker or defibrillator
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8
Q

Effect of IV furosemide

A

Venodilatory effect immediately
Onset diuretic action 30 mins, peaks 60-90mins - decreases circulating volume > decreases afterload > increases CO

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9
Q

Monitoring of IV furosemide

A

HR
BP
CXR
pO2
U&Es
Fluid balance
Hourly urine output
Daily weights - 1kg loss per day aim

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10
Q

Effects of beta blockers

A

Decrease HR
Decrease BP - reduced CO > lower O2 demand
Reduced mobilisation of glycogen
Negate unwanted effects of catecholamines

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11
Q

Investigations for heart failure

A

Echocardiogram (gold standard)
FBC - check for anaemia
U+E
Brain natriuretic peptide
ECG
Chest X ray
Coronary angiography

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12
Q

Why do you want to check for anaemia on a FBC in relation to heart failure?

A

Anaemia can worsen heart failure
Increased work of heart to meet O2 demand

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13
Q

What is brain natriuretic peptide produced by?

A

Stretching of ventricles
To try reduce BP by increasing Na + fluid loss

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14
Q

What does an elevated brain natriuretic peptide level suggest?

A

Heart failure

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15
Q

Aim of pharmacological therapy of chronic heat failure

A

Reduced afterload
Increase CO

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16
Q

What is the best way to diagnose pulmonary oedema?

A

Chest X ray

17
Q

Patient presents with symptoms of heart failure at rest, what classification of heart failure is this?

A

Class IV

18
Q

Non pharmacological treatment of chronic heart failure

A
  • reduce salt + liquid intake
  • avoid salt substitutes
  • reduce alcohol
  • smoking cessation
19
Q

What is the mechanism of action of Sacubitril?
What drug is it often co prescribed with?

A
  • neprilysin inhibition
  • inhibitors natriuretic inactivating enzyme > increases effects of ANP/BNP > natriueiss
  • stops bradykinin breakdown > vasodilation
    .
  • valsartan (ARB)
20
Q

What addition meds can be given is first line treatment of heart failure isn’t successful

A
  • SGLT2 inhibitors e.g. dapaglifozin
  • Sacubitril valsartan
  • ivabradine
  • digoxin
  • hydralazine + nitrate (especially if Afro-Caribbean)
21
Q

What bloods are needed for investigating heart failure?

A
  • renal function
  • FBC
  • LFT’s
  • TFT’s
  • ferritin + transferrin
  • BNP
22
Q

Possible findings on a CXR in heart failure

A
  • cardiomegaly
  • pleural effusions
  • perihilar shadowing/consolidations
  • alveolar oedema
  • air bronchograms
  • increased width of vascular pedicles
23
Q

Pharmacological management of heart failure

A
  • diuretics e.g. furosemide
  • ACE inhibitor e.g. ramipril
  • beta blocker e.g. bisoprolol
  • aldosterone antagonist e.g. spironolactone or eplerenone
  • monitor U&Es
24
Q

What is the action of BNP?

A
  • Relaxes vascular smooth muscle > reduces systemic vascular resistance
  • promotes water excretion by kidneys > reduced circulating volume
25
Q

Management of acute left ventricular failure

A
  • sit up
  • O2
  • diuretics
  • stop IV fluids
  • identify underlying cause
  • monitor fluid balance
  • inotropes + vasopressors if needed

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