Heart Failure Flashcards
Exacerbating factors of HF - FAILURE
- forgot medication
- arrhythmia/anaemia
- ischaemia/infarction/infection
- lifestyle
- upregulation of CO2
- renal failure
- embolism/exercise
HF features due to high filling pressures
- p oedema
- dyspnoea
- orthopnea
- tachypnoea
- exercise intolerance
- paroxysmal nocturnal dyspnoea
- basilar crackles
- jugular venous distension
- hypoxemia
- fatigue
- peripheral oedema
- hepatomegaly
HF features due to low cardiac output
- tachycardia
- hypotension
- cool extremities
- — pulse pressure
- — urine output
- — appetite
XR features of HF
- cardiomegaly
- enlarged vessels
- pericardial & pleural effusions
HF EF on echocardiogram
<50%
Why is BNP.pro-BNP released in HF
Released when overstretched myocardium
Actions of BNP
- relax smooth muscle —> — TPR
- diuretic
Why is serum creatinine & blood urea nitrogen (BUN) raised in HF
— GFR due to hypoperfusion
Why is serum total bilirubin & aminotransferase raised in HF
Congestive hepatopathy due to RSHF
Why is serum lactate raised in HF
Cardiogenic shock
Medication given in HF (ABALM)
- ACEi (unless contraindicated)
- BB
- aldosterone agonist (if A&B not enough)
- mineralocorticoid receptor antagonist
- acute decomposition
Steps for acute decomposition (PONDS)
- position & pour away (stop IV fluids)
- o2
- nitrates
- diuretics
- sit patient up
Indications for cardiac resynchronisation therapy device
- wide QRS
- EF <35%
Drug that confers no mortality benefit in HF
Digoxin
Substance that has a high negative predictive value that should be measured before a referral is made to cardiology for HF when the symptoms fit
BNP
Physiologically what is decreased in systolic HF
Contractility
Physiologically what is decreased in diastolic heart failure
Compliance —> filling
The deficiency of what molecule and what other conditions are associated with high output HF
- thiamine
- anaemia
- thyroid disease
- A-V fistula
HFpEF (EF >55%) is found in
Diastolic HF
Best drug in acute HF is … It leads to reduced CO and increased TPR through the activation of which two systems by decreasing the preload
- ferusomide
- RAAS
- SNS
How do venous vasodilators (nitroglycerin) help relieve dyspnoea symptoms by decreasing preload
Blood moves to veins —> — LVEDV
A drug that is great for advanced HF because it increases contractility and decreases afterload by inhibiting PDE3 enzymes which increases ….
- Milrinone
- cAMP
HF signs on CXR (ABCDE)
Bdbd
1st line meds
ACEi AND BB
2nd line med
aldosterone antagonist
3rd line meds that should be initiated by a specialist
- ivabradine
- sacubitril-valsartan
- hydralazine in combo with nitrates
- digoxin
- cardiac resynchronisation therapy
