Heart Failure Flashcards
Define heart failure
Inadequate cardiac output to meet the body’s requirements
Systolic and diastolic heart failure can be differentiated by ejection fraction of what percentage?
What is ejection fraction?
What is a normal ejection fraction?
Systolic heart failure ejection fraction <40%
Diastolic heart failure ejection fraction >50%
Ejection fraction is the percentage volume of blood ejected (squeezed) out per ventricular contraction, normal >50%
Acute pulmonary edema normally goes alongside what type of heart failure?
Acute LV failure
In acute LV failure, there is an inability to supply the [body or lungs] with blood, and causes a backlog of blood in _____ and ____. Increased pressure in these vessels causes _____.
In acute LV failure, there is an inability to supply the BODY with blood, causes a backlog of blood in the LA and PULMONARY CIRCULATION causing PULMONARY OEDEMA
In pulmonary oedema the alveoli and lung tissues are full of _____, this impairs gas exchange, which results in _____ and ______
In pulmonary oedema the alveoli and lung tissues are full of INTERSTITIAL FLUID, this impairs gas exchange, which results in SOB and OXYGEN DESATURATION
What is decompensated heart failure?
Acute heart failure in a patient with a history of chronic HF
Excess IV fluids in a frail elderly patient with impaired LV function can cause what type of heart failure?
Acute LV failure and pulmonary edema
Of the following symptoms, which are signs of right and which of left HF?
- Cough
- Frothy pink white sputum
- Peripheral edema
- 3rd heart sound
- Bibiasal crackles
- Raised JVP
Cough = left Frothy sputum = left Peripheral edema = right 3rd heart sound = left Bibasal crackles = left Raised JVP = right
Does acute LV failure cause type 1 or type 2 respiratory failure? Normal or low O2? Normal or high CO2
Type 1
Low O2
Normal CO2
Standard investigations for acute LV failure
ECG ABG CXR Bloods incl BNP Echo
BNP is a hormones released from the _____ when the myocardium is _____, if high it suggests the heart is overloaded with blood
BNP is a hormones released from the VENTRICLES when the myocardium is STRETCHED, if high it suggests the heart is overloaded with blood
The breathlessness in acute LV failure improves lying down or sitting up?
Improves sitting up
(Other signs: rapid onset SOB, feel unwell, cough, frothy sputum, raised RR + HR, 3rd heart sound, bibasal crackles, most have a normal BP)
How is ejection fraction measured?
On echo
What is seen on CXR in acute LV failure?
Cardiomegaly (cardiothoracic ratio >0.5)
Upper lobe venous diversion
May also see bilateral pleural effusions
May also see Kerley B lines
Management of acute LV failure
Stop IV fluids Sit patient upright Oxygen IV furosemide 40mg stat Monitor fluid balance
What type of drug is bumetanide?
Loop diuretic (strong one)
What is orthopnea?
Breathlessness when lying flat (ask how many pillows they sleep with)
What is PND?
Paroxysmal nocturnal dyspnoea (wake up in right gasping for breath and coughing)
A wheeze and weight loss are signs of chronic heart failure. T or F
True
What is commonest valvular disease to cause heart failure?
Aortic stenosis
What diagnostic criteria is used for acute heart failure?
Framingham criteria
What investigations in primary care for new HF presentation?
Bloods incl BNP
CXR
If BNP high arrange echo
What causes a high output heart failure?
Paget’s disease of bone
Anaemia
Hyperthyroidism
(High output HF is rare)
What is Kussmaul’s sign? Is it seen in right or left heart failure?
Paradoxical rise in JVP on inspiration
Seen in RHF
1st and 2nd line management of chronic heart failure
1st ACEI + BB
2nd add spironolactone
Furosemide used for symptom relief
What BB is used for chronic HF
Bisoprolol
ACEI and spironolactone both cause what electrolyte disturbance?
Hyperkalaemia
What drug is good for chronic heart failure with co-existing AF?
Digoxin
Cor pulmonale is right sided heart failure caused by respiratory diseasr. What is the commonest cause of cor pulmonale?
COPD
