Heart Failure Flashcards
What is heart failure?
The state in which the heart is unable to pump blood at a rate commensurate with requirements of the tissues or can only do so from high pressures`
What are 4 reasons cardiac failure may be important with regards to dentistry?
- Common and potentially serious condition
- Treatments may impact dental procedures
- Dental problems may affect cardiac function
- Patients may mention symptoms to be aware of
Describe the prevalence of heart failure in the UK
- Around 550,000 people in the UK with heart failure
- Prevalence fairly steady but gradually increasing
- Increasing due to people surviving more complex heart conditions
- Older population more affected
- Survival from myocardial infarction has increased risk of failure
Describe 4 things needed for a functioning heart
- Healthy muscle with healthy blood supply
- Intact valves
- Intact vessels
- Intact cardiac cycle
What is HFrEF?
- Systolic HF
- Reduced systolic function i.e blood ejected in each systolic contraction is reduced as heart muscle cannot squeeze as well
- EF < 40%
- Target of majority of therapies
What is HFpEF?
- Diastolic failure
- Cardiac muscle will not allow the heart to fill properly, usually due to hypertrophy of the muscle
- EF > 50%
Describe 4 common causes of heart failure
- Coronary artery disease (70% cases)
- Hypertension
- Vascular disease
- Diabetes Mellitus (cardiomyopathy and progression of CAD)
What is myocarditis?
Acute inflammation of heart caused by viral factors
Name 5 uncommon causes of heart failure
- Myocarditis
- Congenital heart defects
- Tachyarrhythmia
- Cardiomyopathy
- Chronic disease
Describe 4 components of the presentation of heart failure
- Dyspnoea
- PND (specific form of dyspnoea)
- Swelling / Dependent oedema
- Fatigue / Weight gain
Describe 3 pulmonary clinical findings of heart failure
- Respiration distress
- Crepitations (cracking on breathing)
- Wheeze
Describe 5 cardiac clinical findings of heart failure
- Bradycardia / Tachycardia
- Displaced apex beat
- Raised JVP
- Extra heart sounds
- Murmurs
Describe 2 clinical findings of heart failure in the abdomen
- Ascites
2. Hepato-jugular reflux
Describe 4 clinical findings of heart failure in extremities
- Cool
- Dependent oedema
- Cyanosis
- Pallor
Describe the 5 main clinical findings of right sided heart failure
- Oedema
- Ascites
- Pleural effusions
- Raised JVP
- Hepatomegaly
Describe 3 main clinical findings of left sided heart failure
- Pulmonary oedema
- Low blood pressure
- Fatigue
Describe why pulmonary oedema occurs in heart failure
- Increased LV diastolic pressure, increased LA pressures and increased pulmonary venous and capillary pressures
- Pulmonary capillary pressure exceeds oncotic pressure
- Fluid enters the alveoli
Describe 5 patient symptoms of pulmonary oedema
- Fighting for breath
- Distressed, clammy and cyanosed
- Rapid respiratory rate
- Profuse frothy pink sputum
- Crepitations and rhonchi
What is orthopnoea?
Breathlessness on lying down due to increased venous return
What is paroxysmal nocturnal dyspnoea?
Due to fluid shifts from interstitial tissues to circulation whilst laying down resulting in pulmonary oedema
Describe NYHA classification of heart failure
Class I - No limit on physical activity
Class II - Comfortable at rest with slight limitation of physical activity
Class III - Comfortable at rest with marked limitation and discomfort on less than ordinary activity
Class IV - Discomfort at rest
Describe 5 complications of heart failure
- Renal failure
- Impaired liver function
- Thrombo-embolism
- Ventricular arrhythmias
- Sudden death
Describe 5 components of diagnosis of heart failure
- ECG is mandatory
- Chest X-Ray
- Laboratory testing
- Echocardiography
- MRI
Describe 4 things to look for chest x-rays
- Pulmonary venous congestion
- Interstitial oedema
- Cardiomegaly
- Pleural effusions
Describe lifestyle management of cardiac failure
- Vaccinations against flu and pneumococcal infections
- Alcohol and tobacco cessation
- Weight management
- Avoidance of contra-indicated medication
- Fluid management
Describe 2 drugs which improve symptoms of heart failure
- Diuretics
2. Digoxin
Describe 5 types of drugs which improve survival of heart failure
- B-blockers
- Ivabradine
- ACE inhibitors
- Aldosterone blockers
- ARBs
Describe, basically, how ACE inhibitors, aldosterone blockers and ARBs improve survival of patients with heart failure
Knock out steps in renin-angiotensin system to prevent production of AT1 and AT2
Describe ACE inhibitors as a therapy for heart failure
- First line therapy in all patients
- Initial therapy in absence of fluid retention
- Initiate even in transient heart failure post MI
- Titrate doses to maximum and not based on symptoms
Describe ARBs as a therapy for heart failure
- Alternative to ACE inhibitors in symptomatic patients intolerant to ACE inhibitors
- Similar effect to ACE inhibiors
- Used in MI with heart failure or LV dysfunction
Name 2 aldosterone antagonists
- Spironolactone
2. Eplerenone
Name 2 side effects of aldosterone antagonists
- Hyperkalaemia
2. Renal dysfunction
Describe beta blockers as a treatment for heart failure
- Recommended for all patients NYHA II - NYHA IV on standard treatments
- Reduce mortality in LV systolic dysfunction post MI
Describe ivabradine as a therapy for heart failure
- Only used in SR
- Used in heart failure if beta blocker contra indicated or if on maximum dose of B-blocker
Describe digoxin as a therapy for heart failure
Symptom relief in absence of arrhythmias
Describe 3 indications for cardiac resynchronisation therapy
- Moderate to severe CHF who have failed optimal medical therapy
- EF < 30%
- Evidence of electrical conduction dleay
Describe 4 ways to treat acute heart failure
- Oxygenation and fluid restriction
- Diuretics if fluid overloaded
- IV nitrates if blood pressure stable with vasodilator
- Inotropes to improve cardiac output
