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Medicine > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is Heart Failure?

A

Heart Failure is described as when the cardiac output is inadequate for the body’s requirments

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2
Q

What is the incidence of Heart Failure in the general population?

A

1-3%

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3
Q

What is the incidence of heart failure in the elderly population?

A

~10%

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4
Q

What are 3 classifications of heart failure

A

Systolic and Diastolic
Left and Right Heart Failure
Acute and Chronic

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5
Q

What is Systolic Heart Failure

A

The inability of the ventricles to contract normally resulting in a decreased cardiac output

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6
Q

In systolic heart failure, what is the ejection fraction

A

<40% HFrEF

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7
Q

List three causes of Systolic Heart Failure

A

Ischaemic Heart Disease
Cardiomyopathy
Myocardial Infarction

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8
Q

What is Diastolic Heart Failure

A

This is when the ventricles are unable to relax and fill normally, which then leads to increased filling pressures

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9
Q

What is the ejection fraction in diastolic heart failure

A

> 50% HFpEF

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10
Q

List 5 causes of diastolic heart failure

A

Ventricular Hypertrophy
Constrictive Pericarditis
Tamponade
Restrictive Cardiomyopathy
Obesity

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11
Q

List symptoms of Left Sided (Ventricular) Heart Failure

A

Dyspnoea
Paroxysmal Noctornal Dyspnoea
Orthopnea
Wheezing
Nocturia
Night Time Dry Cough
Fatigue
Weight loss
Cold peripheries

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12
Q

List 3 causes of Right sided (ventricular) failure

A

Pulmonary Stenosis
Lung Disease
Left ventricular (sided) failure

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13
Q

List symptoms of Right sided (ventricular) failure

A

Pulmonary Hypertension
Peripheral Oedema (thighs, sacrum, abdomen)
Ascites
Anorexia
Facial engorgement
Epistaxis
Nausea

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14
Q

Left Ventricular and Right Ventricular Heart Failure is collectively called

A

Congestive Cardiac Failure

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15
Q

How does congestive heart failure cause nocturia

A

When in the recumbent position, the fluid in the legs is no longer being held down by gravit. It can now moore easily enter the veins and the kidney for filtration, leading to the nocturia

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16
Q

What is acute heart failure?

A

Acute heart failure is new onset acute or decompensated heart failure characterized by the onset of pulmonary/peripheral odema with or without hypoperfusion signs.

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17
Q

What is Chronic Heart Failure

A

This is a gradual and slow progression of heart failure. Venous congestion is common but arterial pressures are well maintained until late

18
Q

What is Low output cardiac failure?

A

This is when cardiac output is decreased and fails to increase on exertion to meet requirements.

19
Q

List three cause of Low cardiac output failure

A

-excessive preload : Preload is the force that stretches the cardiac muscle prior to contraction. This force is composed of the volume that fills the heart from venous return.

-pump failure

-excessive afterload :
The afterload is the amount of vascular resistance that must be overcome by the left ventricle to allow blood to flow out of the heart

20
Q

List some causes of excessive preload in Low Cardiac Output Failure

A

Mitral Regurgitation
Fluid Overload (renal failure, excess IV fluids)

21
Q

List some causes of pump failure in Low Cardiac Output Failure

A

Systoli/Diastolic Heart Failure
B Blockers
Myocardial Infaction
Heart Block
Negative Inotropes

22
Q

List some causes of chronic excessive afterload Low Output Cardiac Failure

A

Aortic Stenosis
Hypertension

The afterload is the amount of vascular resistance that must be overcome by the left ventricle to allow blood to flow out of the heart

23
Q

What is High Output Cardiac Failure

A

Cardiac output is higher than normal due to increased peripheral demand. There is circulating overload which may lead to pulmonary edema secondary to elevated diastolic level in left ventricle

24
Q

List some causes of High Output Cardiac Failure

A

Anemia
Pregnancy
Hyperthyroidism

25
Q

List one complication of High Output Cardiac Failure

A

Right sided failure becomes left sided failure

26
Q

List some clinical signs of Heart Failure

A

Cyanosis
Decreased BP
Narrow Pulse Pressure
Pulsus Alterans
Displaced apex (LV dilatation)
Right Ventricle Heave (pulmonary hypertension)
Signs of valve disease (murmur?)
Severity (according to NYHA)

27
Q

What could a displaced apex beat indicate

A

Left Ventricle dilatation

28
Q

What could a right ventricle heave indicate

A

Pulmonary Hypertension

29
Q

Which investigations are done in Heart Failure?

A

CBC : Anemia, Infection
UandE : Kidney & Thyroid Function Tests
ECG : Heart Blocks, Bradycardia
BNP - B-type natiuretic protein:
Echocardiography:
Chest X-Ray:

30
Q

What are the five (5) steps to management of Heart Failure

A

1) Lifestyle Changes
2) Treat the cause
3) Treat exacerbating factors
4) Avoid Exacerbating factors
5) Pharmacotherapy

31
Q

What lifestyle changes should be advised in a patient with Heart Failure

A

Stop Smoking
Low salt intake
Stop drinking alcohol
Optimize weight and nutrition

32
Q

What are some exacerbating factors of Heart Failure

A

anemia
thyroid disease
infection
high blood pressure

33
Q

What are some drugs that can exacerbate Heart failure and should be avoided in treating these patients

A

NSAIDs (fluid retention)
Negative Inotropes - Verapamil (CCB)

34
Q

What are the 4 (four) pillars of Heart Failure Treatment

A
  • ACE-i (Lisinopril)
  • SGLT2 inhibitors (Gliflozin)
  • B-Blocker (Carvedilol)
  • Aldosterone Antagonist (Spirinolactone/Eplerenone)

OR

2022 Edition
1) Neprilysin Inhibitor + ARB (Vymada)
2) SGLT2i (Dapagliflozin, Empagliflozin)
3) Beta Blocker ( Carvedilol, Metoprolol, Bisoprolol)
4) Aldosterone Antagonist (Spirinolactone, Eplerenone)

35
Q

What does the FRAMINGHAM CRITERIA for Congestive Cardiac Failure State

A

Diagnosis of CCF requires simultaneous presence of 2 major criteria OR 2 minor and 1 major criteria

36
Q

What is the threshold for B-type Natiuretic peptide that “confirms” heart failure

A

> 100mg/L

37
Q

BNP at what value is used to rule out Heart Failure

A

<50ng/L (96% accurate)

38
Q

What is Heart Failure with reduced Ejection Fraction

A

<40%

39
Q

What is Heart Failure with mid-range Ejection Fraction

A

40-49%

40
Q

What is Heart Failure with preserved Ejection Fraction

A

> 50%

41
Q

What is normal Ejection Fraction

A

55-70%

Medicine (14 decks)

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