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Year 3 Cardio > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

How can HF be classified?

A

Ejection fraction
Time
Left/Right

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2
Q

How do you measure ejection fraction?

A

Echocardiography
Reduced left ventricular ejection fraction is defines as < 35-40%
= HF-rEF

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3
Q

What % of patients with HF have HF-rEF?

A

50%

Remaining have HF-pEF

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4
Q

What causes HF-rEF?

A 
Systolic dysfunction e.g. 
IHD
Dilated cardiomyopathy
Myocarditis
Arrhythmias
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5
Q

What causes HF-pEF?

A 
Diastolic dysfunction e.g. 
HOCM
Restrictive cardiomyopathy
Cardiac tamponade
Constrictive pericarditis
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6
Q

How do we classify HF by time?

A

Acute - exacerbation

Chronic

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7
Q

How do we classify HF by side?

A

Left/Right

Typically lefy

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8
Q

What can cause left sided heart failure?

A

Increased ventricular afterload
e.g. arterial hypertension or aortic stenosis

Increased left ventricular preload
e.g. aortic regurgitation causing backflow

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9
Q

What can cause right sided heart failure?

A

Increased right ventricular afterload e.g.
Pulmonary HTN

Increased right ventricular preload
e.g. Tricuspid regurgitation

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10
Q

What are the symptoms of left-sided heart failure?

A

pulmonary oedema

  • dyspnoea
  • orthopnoea
  • paroxysmal nocturnal dyspnoea
  • bibasal fine crackles
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11
Q

What are the symptoms of right-sided heart failure?

A 
peripheral oedema
- ankle/sacral oedema
raised jugular venous pressure
hepatomegaly
weight gain due to fluid retention
anorexia ('cardiac cachexia')
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12
Q

What is high output HF?

A

situation where a ‘normal’ heart is unable to pump enough blood to meet the metabolic needs of the body

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13
Q

What are some causes of high output HF?

A 
anaemia
arteriovenous malformation
Paget's disease
Pregnancy
thyrotoxicosis
thiamine deficiency
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14
Q

What is AHF?

A

Acute HF
sudden onset or worsening of the symptoms of heart failure
Usually in pts >65

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15
Q

What usually causes AHF?

A

Reduced cardiac output that results from a functional or structural abnormality

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16
Q

What can cause de-novo AHF?

A 
Increased cardiac filling pressures
Myocardial dysfunction
Usually both caused by ischaemia 
Decreased CO 
Hypoperfusion
17
Q

What are the most common precipitating causes of AHF?

A

Acute coronary syndrome
Hypertensive crisis
Acute arrhythmia
Valvular disease

18
Q

What are the symptoms of AHF and corresponding signs?

A

Breathlessness - Cyanosis

Reduced exercise tolerance - Tachycardia

Oedema - Raised JVP

Fatigue - displaced apex beat

S3 heart sound

Bibasal crachles +/- wheeze

19
Q

What investigations are done for AHF?

A

Bloods - anaemia, electrolytes, infection

CXR - oedema, cardiomegaly

Echo - pericardial effusion and cardiac tamponade

BNP

20
Q

What BNP levels indicates myocardial damage?

21
Q

What is the treatment for HF?

A

IV loop diuretics e.g. furosemide

+/-
O2
Vasodilators e.g. nitrates

22
Q

What is done for HF pts with resp failure?

23
Q

When should beta blockers be stopped inHF?

A

Brady
2nd/3rd degree heart block
Shock

24
Q

What are the investigations for chronic HF?

A

BNP
hormone produced mainly by the left ventricular myocardium in response to strain

Gold-standars is echo

25
Q

What factors increase BNP?

A 
Left ventricular hypertrophy
Ischaemia
Tachycardia
Right ventricular overload
Hypoxaemia (including pulmonary embolism)
GFR < 60 ml/min
Sepsis
COPD
Diabetes
Age > 70
Liver cirrhosis
26
Q

What would decrease BNP?

A 
Obesity
Diuretics
ACE inhibitors
Beta-blockers
Angiotensin 2 receptor blockers
Aldosterone antagonists
27
Q

What are the signs and symptoms of chronic HF?

A 
Dyspnoea
Cough - worse at night, pink frothy sputum
Orthopneoa/Paroxysmal nocturnal dyspnoea
Wheeze
Weight loss - can be hidden by gain 2ry to oedema
Bibasal crackles
Raised JVP
Ankle oedema
S3 gallop
28
Q

What is the first line treatment for chronic HF?

A

ACEi
Betablocker e.g. bisoprolol
Start one at a time
Does not work in HF-pEF

29
Q

What is second line treatment for chronic HF?

A

Aldosterone anatagonist

e.g. spironolactone

30
Q

What must be monitored in patients on ACEi and Aldosterone antagonsists?

A

Potassium

Can induce hyperkalaemia

31
Q

What is myocarditis?

A

myocardial inflammation in the absence of predominant acute or chronic ischaemia

32
Q

What are some key diagnostic features of myocarditis?

A

Prior viral infection
Autoimmune disease
Infectious disease

33
Q

What are some presenting features of myocarditis?

A 
Chest pain
Dyspnoea
Orthopnea
Fatigue
Palpitations
S3 gallop
34
Q

What would be seen on an ECG in myocarditis?

A

non-specific ST-segment and T-wave abnormalities

Year 3 Cardio (12 decks)

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