Heart failure Flashcards
How common is heart failure?
-1 in 7 in >85s
-Average age at diagnosis is 76
-Half have preserved EF (diastolic) and half have reduced (systolic)
Who does heart failure affect?
-Most commonly those with CHD and previous MIs
What causes heart failure?
-Myocardial disease (CHD, HTN, cardiomyopathies)
-Valvular disease
-Pericardial disease (effusion, constrictive pericarditis)
-Arrhythmias
-High output states (anaemia, thyrotoxicosis, pheochromocytoma, liver failure, B1 deficiency)
-Volume overload (end stage CKD, nephrotic syndrome)
-Obesity
-Drugs (alcohol, cocaine)
NB NSAIDs, beta blockers and CCBs can worsen heart failure
How does heart failure present?
-SOB on exertion, at rest and lying flat
-Nocturnal cough
-PND
-Fluid retention
-Fatigue, decreased exercise tolerance
-Light headedness / syncope
What signs might a hear failure patient have on examination?
-Tachycardia
-Displaced apex beat, heart murmurs and 3rd and 4th heart sounds (gallop)
-HTN
-Raised JVP
-Enlarged liver
-Tachypnoea, pleural effusions
-Dependent oedema
What are the differential diagnoses for heart failure?
-Severe anaemia, thyroid disease
-Renal artery stenosis
Breathlessness:
-COPD
-Asthma
-Lung cancer
-Anxiety
Peripheral oedema
-Prolonged inactivity
-Nephrotic syndrome
-Drugs
-Hypoalbuminaemia
How would you investigate a patient with suspected heart failure?
-ECG
-CXR
-Echo
-FBCs, U+Es, LFTs, eGFR, TFTs, HbA1c, fasting lipids
-BNP
-Urine dip for blood / protein
-Lung function est
What treatment would you consider for someone with heart failure?
Systolic:
-Lifestyle advice
-Relieve symptoms of fluid overload with loop diuretic (furosemide)
-Prescribe an ACEi and beta blocker (starting one at a time to avoid hypotension)
-Clopidogrel / aspirin for those with atherosclerosis
-?Statin
-Cardiac rehab
Diastolic:
-Same but do not give ACEi or beta blocker
