Heart Failure Flashcards
Heart Failure
A pathophysiological process in which the heart as a pump is unable to meet the metabolic requirements of the tissue for oxygen and substrates despite venous return to the heart being normal or increased
Congestive heart failure
A chronic, progressive , complex clinical conditions where inadequate cardiac pumping means that cardiac output falls leading to slowing/reduction of blood flow, back-up or congestion of blood in the veins and organs and fluid retention in the tissues (oedema)
CHF types (2)
Systolic HF Reduced ejection fraction (HFpEF) - can’t pump hard enough - reduced ejection fraction
Diastolic HF/ Preserved ejection fraction (HFpEF) - can’t fill enough
Ejection Fraction
SV/TV *100
normal 50-70%
<40% HF/ Cardiomyopathy
41-49% borderline
> 75% Hypertrophic cardiomyopathy
LSHF def and causes
mainly Systolic Heart Failure - failure in pumping
Ischaemic Heart Disease (atherosclerosis) - damage to myocardium
Long standing Hypertension - hypertrophy- weaker contractions
Dilated cardiomyopathy - think weak, enlarged chamber
LSHF Diastolic Heart Failure def and causes
Filling failure
Long standing Hypertension - concentric hypertrophy
Aortic stenosis - narrowing
Hypertrophic cardiomyopathy - genetic
Restrictive cardiomyopathy - stiff, less compliant to stretch
RSHF causes and signs
LSHF L-R intracardiac shunt - atrial/ventricular septal defect Chronic lung disease - Cor Pulmonale ( Pbp > hypertrophy - HF JV distension Pitting oedema Hepato spleno megaly Ascites Cardiac cirrhosis
Acute heart failure causes
Iatrogenic
Sepsis
Myocardial infarction
Arrhythmias
OE in Acute HF
Increased RR Tachycardia Red O2 3rd hear sound Bilateral crackles - wet sounding Hypotension - if cardiogenic (worrying)
Management of Acute HF
ECG ABG (T1RF) CXR Bloods including BNP > HF and Troponin >ACS ECG to confirm BNP Stop IV fluids, restrict fluids 1.5ltrs Sit them up O2 Diuretics (Furosemide IV 40mgs IV) Inotropes
Chronic HF causes
IHD
Valvular Disease -aortic stenosis
Hypertension
Arrhythmias (offer atrial fibrillation)
Management of chronic HF
Referral if BNP >2000 Surgery - aortic stenosis or mitral regurgitation HF nurse Yearly flu and pneumococcal vaccine Smoking Cessation Treat comorbidities Exercise as much as tolerated Medical management
Medical Management of Chronic HF
A-Ace inhibitors such as ramipril (up to 10mg OD)
B- Beta blockers such as bisoprolol (up to 10mg OD)
A-Aldosterone antagonist if not controlled by A+B alone like spironolactone
L- Loop diuretics for symptomatic relief furosemide 40mg OD starting dose
Monitor U&Es if on diuretics, Ace inhibitors, aldosterone antagonist due to electrolyte disturbances.
Can use an ARB like candesartan up to 32mg OD if Ace inhibitors not tolerated
