heart failure Flashcards
systolic heart failure
impaired contraction during systole
diastolic heart failure
impaired ventricular filling during diastole
causes of systolic HF
IHD
dilated cardhopmyopathy
infiltration - haemochromatosis, sarcoidosis
causes of diastolic HF
hypertrophic cardiomyopathy
restrictive cardiomyopathy
cardiac tamponade
constrictive pericarditis
high output cardiac failure
normal CO, but cant keep up with peripheral demand
anaemia AV malformation Paget's pregnancy thyroxicosis
symptoms of L heart failure
SOB
orthopnoea
PND
cough +/- frothy sputum
signs of L sided HF
tachypnoea bibasal fine crackles cysnosis prolonged CRT pulses alterans S3 gallop rhythm
symptoms of R sided heart failure
ankle swelling
weight gain
abdo discomfort
signs of R sided HF
raised JVP
pitting oedema
ascites
transudative pleural effusions
NYHA class I
no limitation physical activity
activity ≠ fatigue, SOB, palpitations
NYHA class II
slight limitation
comfort at rest
ordinary activity = fatigue
NYHA class III
marked limitation
comfort at rest
minimal activity = fatigue
NYHA class IV
unable to carry out any activity w/o discomfort
symptoms at rest
BNP > 2000
2wk wait referral
BNP 400-2000
6wk wait referral
CXR findings
alveolar oedema kerley B lines cardiomegaly upper lobe blood diversion pleural effusions fluid in horizontal fissure
pharmacological Mx
ACE I and beta blocker
loop diuretic
improving mortality - if cant tolerate ACEI
ARB
improving mortality - if can’t tolerate ACI and ARB
hydralazine and silver nitrate
Mx - symptoms persisting or class 3/4
aldosterone antagonist
hydralazine and nitrate if afro carribean
when is ICD indicated
- QRS <120, high risk death, class 1-3
- QRS 120-149, class 1-3
- QRS 120-149, LBBB, class 1
acute Mx pulmonary oedema
sit up
oxygen therapy - aim sats >94%
IV furosemide 40g
side effects/ beta blckers
hypotension
bradycardia
adverse effects/ ACEI
hyperkalaemia
dry cough
adverse effects/ spironolactone
hyperkalaemia
gynaecomastia
adverse effects/ furosemide
hyponatraemia
hypokalaemia