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Finals - CardioResp > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

List the 4 key phases of the cardiac cycle

A
  1. Isovolumetric Relaxation
  2. Filling Phase
  3. Isovolumetric contraction
  4. Ejection Phase

(1 + 2 diastole 3 +4 systole)

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2
Q

Equation for BP

A

BP = CO x TPR

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3
Q

Equation for CO

A

CO = SV x HR

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4
Q

List the 3 mechanisms in HF that act to preserve BP

A
  1. Frank Starling
  2. Neurohormonal (SNS, RAAS, ADH)
  3. Ventricular hypertrophy (remodelling)
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5
Q

Explain the Frank Starling Mechanism

A
  1. In HF there is ↓ CO and SV
  2. leads to ↓emptying, ↑EDV
  3. results in ↑stretch, ↑ SV, ↑emptying and CO

UP TO A POINT

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6
Q

Explain SNS activation in HF

A

Baroreceptors in carotid sinus and aortic arch detect ↓ CO and ↑ SNS outflow:

  1. ↑cardiac contractility
  2. ↑ vasoconstriction (arteries and veins)
  3. ↑ Heart rate
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7
Q

Explain RAAS activation in HF

A
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8
Q

Explain ADH activation in HF

A
  1. Osmoreceptors in hypothalamus detect high osmolarity
  2. ADH released from posterior pituitary
  3. ↑ H2O retention
  4. ↑ intravascular volume and preload
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9
Q

What is heart failure?

A

Failure of the heart to generate sufficient CO to meet the metabolic demands of the body

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10
Q

What are the types of heart failure?

A

R vs L
Systolic vs Diastolic

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11
Q

List 4 symptoms of Right sided heart failure

A
  1. Ankle swelling
  2. Weight gain
  3. Abdominal distension and discomfort
  4. Anorexia / nausea
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12
Q

List 4 signs of Right sided heart failure

A
  1. Raised JVP
  2. Pitting ankle/sacral oedema
  3. Tender smooth hepatomegaly
  4. Ascites
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13
Q

List 4 symptoms of left sided heart failure

A
  1. Shortness of breath on exertion
  2. Orthopnoea
  3. Paroxysmal nocturnal dyspnoea
  4. Nocturnal cough (± pink frothy sputum)
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14
Q

List 4 signs of left sided heart failure

A
  1. Tachypnoea
  2. Bibasal fine crackles and wheeze
  3. Cyanosis
  4. Prolonged CRT
  5. Hypotension
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15
Q

List 3 less common signs of left heart failure

A
  1. Pulsus alternans (alternating strong and weak pulse)
  2. S3 gallop rhythm (filling of a stiffened ventricle)
  3. Features of functional mitral regurgitation
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16
Q

List 4 causes of Systolic heart failure

A
  • Ischaemic heart disease
  • Dilated cardiomyopathy
  • Myocarditis
  • Infiltration (e.g. in haemochromatosis or sarcoidosis)
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17
Q

List 4 causes of diastolic heart failure

A
  1. Hypertrophic obstructive cardiomyopathy
  2. Restrictive cardiomyopathy
  3. Cardiac tamponade
  4. Constrictive pericarditis
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18
Q

What is high output cardiac failure?

A

CO is normal, but there is an increase in peripheral metabolic demands which exceed those that can be met with maximal cardiac output

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19
Q

List 4 causes of high output cardiac failure

A
  1. Anaemia
  2. Arteriovenous malformation
  3. Paget’s disease
  4. Pregnancy
  5. Thyrotoxicosis
  6. Thiamine deficiency (wet Beri-Beri).
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20
Q

What classification system is used for heart failure?

A

New York Heart Association (NYHA) Classification of Heart failure

Grades severity of exertional dyspnoea

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21
Q

Explain the NYHA classification

A

Class I - no limitation in physical activity

Class II - slight limitation of physical activity

Class III - marked limitation in physical activity

Class IV - inability to carry on any physical activity

22
Q

Investigations for heart failure?

(In order)

A
  1. NT-proBNP
  2. ECG
  3. FBC
  4. Chest X-ray
  5. Echocardiogram
23
Q

What is NT-proBNP?

List 3 of its actions

A

Released by ventricles in response to myocardial stretch. Works to balance effects of RAAS:

  1. ↑excretion of Na and H2O
  2. vasodilation
  3. ↓ renin and AT II
24
Q

What values of NT-proBNP, in GP, require specialist referral?

What investigation is performed by the specialist to confirm diagnosis?

A
  • BNP > 2000ng/L - urgent 2 week referral
  • BNP 400-2000ng/L - 6 week referral

Referred to specialist for trans-thoracic echocardiogram

25
Q

What is the purpose of an Echocardiogram in HF?

A

Can show the presence and degree of ventricular dysfunction

Measured by the ejection fraction

26
Q

EF values indicative of systolic vs diastolic HF

A

< 40% (reduced EF) = systolic

> 40% but raised BNP (preserved EF) = diastolic

27
Q

Blood tests in HF and why

A
  1. U+Es - renal function
  2. LFTs - hepatic congestion
  3. TFTs - hyperthyroidism
  4. HbA1C and lipid profile - modifiable risk factors
  5. BNP
28
Q

List 5 chest x-ray findings in heart failure

(ABCDEF)

A
  1. Alveolar oedema (‘batwing’ perihilar shadowing)
  2. Kerley B lines (due to interstitial oedema)
  3. Cardiomegaly
  4. upper lobe blood diversion
  5. Pleural Effusions (bilateral transudates)
  6. Fluid in the horizontal fissure
29
Q

What value indicates cardiomegaly on x-ray?

A

cardiothoracic ratio > 0.5

30
Q

List 3 lifestyle modifications for HF

A
  1. Smoking cessation
  2. Salt and fluid restriction
  3. Supervised cardiac rehabilitation
31
Q

Pharmacological management for HF

(ABAL)

A
  1. ACE inhibitor (eg. ramipril)
  2. Beta Blocker (eg. bisoprolol)
  3. Aldosterone antagonist (eg. spironolactone or eplerenone)
  4. Loop diuretics improves symptoms (eg. furosemide)
32
Q

What is Entresto?

A

Valsartan/sacubitril

Used as an alternative to ACEi or ARBs

33
Q

Who is eligible for Entresto

A
  1. Symptomatic heart failure
  2. Severe LVSD
  3. Stable renal function
  4. Good BP
  5. Already on decent dose of ACEi or ARB
34
Q

Surgical/device management option for HF

A

Cardiac resynchronisation therapy in QRS > 130ms

35
Q

What cannot be used alongside Entresto?

A

ACEi due to risk of angioedema

Requires minimum 36 hour washout period

36
Q

Any of what 3 criteria must be fullfilled for an ICD

A
  1. QRS interval <120ms, high risk sudden cardiac death, NYHA class I-III
  2. QRS interval 120-149ms without LBBB, NYHA class I-III
  3. QRS interval 120-149ms with LBBB, NYHA class I
37
Q

What is acute HF?

A

Sudden onset or worsening of the symptoms of HF due to a reduced CO that results from a functional or structural abnormality

38
Q

What are the two ways in which acute HF may arise?

A
  1. De-novo AHF - no PMH of HF
  2. Decompensated AHF (66-75%) - a background history of HF
39
Q

What causes De-novo AHF

A

Ischaemia → increased cardiac filling pressure and myocardial dysfunction

Results in reduced CO → hypoperfusion

Can cause pulmonary oedema

40
Q

List one other cause of De-Novo AHF

A
  • Viral myopathy
  • Toxins
  • Valve dysfunction
41
Q

List 4 triggers of decompensated AHF

A
  1. Acute coronary syndrome
  2. Hypertensive crisis
  3. Acute arrhythmia
  4. Valvular disease
42
Q

List 4 symptoms of AHF

A
  1. Breathlessness
  2. Reduced exercise tolerance
  3. Oedema
  4. Fatigue
43
Q

List 4 signs of AHF

A
  1. Cyanosis
  2. Tachycardia
  3. Raised JVP
  4. Displaced apex beat
  5. Bibasal crackles +/- wheeze
  6. S3 heart sound
44
Q

Initial Management of decompensated AHF

A
  1. Sit patient up
  2. O2 therapy (aim >94%)
  3. IV furosemide
  4. SC morphine
  5. Consider nitrites (it hypoxic or hypertensive)
45
Q

Advanced management of AHF (pulmonary oedema)

(ITU setting)

A
  1. CPAP
  2. Intubation and ventilation
  3. Furosemide infusion
  4. Dopamine infusion
  5. Intra-aortic balloon pump - if in cardiogenic shock
  6. Ultrafiltration
46
Q

List 4 s/e of Beta blockers

A

Bradycardia, hypotension, fatigue, dizziness

47
Q

List 4 s/e of ACEi

A

Hyperkalaemia, renal impairment, dry cough, lightheadedness, fatigue, GI disturbances, angioedema

48
Q

List 4 s/e of spironolactone

A

Hyperkalaemia, renal impairment, gynaecomastia, breast tenderness/hair growth in women, changes in libido

49
Q

List 3 s/e of Furosemide

A

Hypotension, hyponatraemia/kalaemia

50
Q

List 3 s/e of NO

A

Headache, palpitation, flushing

51
Q

List 3 s/e of Digoxin

A

Dizziness, blurred vision, GI disturbances

Finals - CardioResp (18 decks)

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