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B Disease Database > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is heart failure?

A

Heart failure is a complex clinical syndrome in which the heart fails to meet the metabolic demands of the body. It can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood

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2
Q

How is heart failure diagnosed?

A

A diagnosis of heart failure is based on the presence of a triad of typical symptoms (shortness of breath on exertion and at rest, fatigue), signs (tachycardia, tachypnoea, raised jugular venous pressure, peripheral oedema, and pulmonary congestion), and objective evidence of a structural or functional cardiac abnormality (cardiomegaly, abnormal echocardiogram, raised natriuretic peptide concentration).

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3
Q

What are the end-stage results of heart failure?

A

Progressive pump failure

Sudden cardiac death

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4
Q

What pathologies can lead to heart failure?

A

Ischaemic heart disease
Idiopathic dilated cardiomyopathy
Valve disease
Hypertension

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5
Q

What are the physiological causes of heart failure?

A
  1. Volume overload
  2. Pressure overload
  3. Contractile dysfunctioni
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6
Q

What remodeling changes occur in heart failure?

A
  1. Myocardial damage leads to increased myocardial wall stress
  2. Wall thickness increases to reduce wall stress –> increase of myocardiocytes isn’t functional and decrease in CO (diastolic failure)
  3. Hyperdilation of ventricles and severely decreased CO
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7
Q

What are the clinical features of heart failure?

A
  1. Fatigue
  2. Dyspnoea on exertion or at rest
  3. Orthopnoea
  4. Paroxysmal noctural dyspnoea
  5. Peripheral oedema
  6. Chest pain
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8
Q

What are the signs of heart failure?

A
  1. Tachycardia
  2. Hypotension
  3. Raised JVP
  4. Displaced apex beat
  5. 3rd heart sound
  6. Cachexia
  7. Cardiomegaly
  8. Pleural effusion
  9. Ascites
  10. Peripheral ankle oedema
  11. Tender hepatomegaly
  12. Bi-basal crackles
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9
Q

What are the 4 steps in the NYHA classification of heart failure?

A
  1. No limitation pf physical activity
  2. Slight limitation of physical activity (walking up stairs)
  3. Marked limitation of physical activity (getting dressed)
  4. Symptoms at rest
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10
Q

What are the specific symptoms of left-sided heart failure?

A 
Nocturnal dyspnoea
Orthopnea
Tachycardia 
Pulmonary congestion -> cough, crackles, wheezes
Fatigue
Cyanosis 
Exertional Dyspnoea
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11
Q

What are the specific symptoms of right-sided heart failure?

A 
fatigue
Increased peripheral venous pressure
Ascites
Enlarged liver and spleen
Weight gain
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12
Q

How is heart failure diagnosed?

A
  1. Detailed history and clinical examination
  2. Measure NT-proBNP, perform ECG

NT-proBNP > 400-2000 –> heart failure
NT-proBNP < 400, heart failure not confirmed

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13
Q

What does an ECG in heart failure show?

A

No definitive markers for heart failure, but only 2% of patients with heart failure have a normal ECG

  • Often observed:
    • Sinus tachycardia
    • Arrhythmias
    • LVH
    • Evidence of ischaemia or infarction
    • Conduction system defects
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14
Q

What does a CXR in heart failure show?

A

Pulmonary congestion

Cardiomegaly

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15
Q

What does an echocardiography in heart failure show?

A

Key in confirming diagnosis

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16
Q

What do natriuretic peptide levels in heart failure patients show?

A

A normal plasma concentration in an untreated patient has a high negative predictive value, making HF an unlikely cause of symptoms.

17
Q

How would you pharmacologically manage heart failure?

A

First line: offer diuretics for congestive symptoms and fluid retention, then offer ACE-I and beta-blocker

18
Q

What dose would you give furosemide?

A

40 mg daily in the morning

19
Q

What do thiazides do?

A

Thiazides and related compounds are moderately potent diuretics; they inhibit sodium reabsorption at the beginning of the distal convoluted tubule

20
Q

What are examples of thiazides?

A

Bendroflumethiazide
Chlortalidone
Xipamide
Metolazone

21
Q

What do loop diuretics do?

A

The mechanism of action for loop diuretics like furosemide is by inhibiting the apical sodium/potassium/chloride transporter in the thick ascending limb of the loop of Henle

22
Q

What are examples of loop diuretics?

A

Furosemide
Bumetanide
Torasemide

23
Q

Name an example of an aldosterone antagonist

A

Spironolactone

Improves survival in heart failure patient

24
Q

What dose would you give for spironolactone?

A

25-400 mg daily depending on the condition

25
Q

How would you non-pharmacologically manage heart failure?

A
  1. Revascularisation
  2. Biventricular pacemaker
  3. Cardiac transplantation

B Disease Database (21 decks)

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