Heart failure Flashcards

1
Q

how is left ventricular ejection fraction (LVEF) measured

A

echo

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2
Q

how much does LVEF need to be reduced to be termed HF with reduced ejection fraction (HF-rEF)

A

35-40%

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3
Q

how does HF-rEF and HF-pEF related to systole and diastole

A

HF-rEF is usually problem with systole + contraction // HF-pEF is usually problem with diastole + filling

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4
Q

what can cause systolic dysfunction

A

IHD // dilated cardioyopathy // myocarditis // arrythmia

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5
Q

what can cause diastolic dysfunction

A

HCOM // restrictive cardiomyopathy // tamponade // contrictive pericarditis

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6
Q

what side of the heart does HF-rEF and HF-pEF cause failure of

A

left

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6
Q

what side of the heart does HF-rEF and HF-pEF cause failure of

A

left

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7
Q

what can cause right sided HF

A

increased RV afterload (pulm hypertension) // increased right ventricular preload (tricuspid regurg)

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8
Q

symptoms LV HF

A

pulmonary oedea - dyspnoea, orthopnoea, nocturnal dypnosea, basal fine crackles

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9
Q

symptoms RV HF

A

periphal oedema // raised JVP // hepatomegaly // weight gain (fluid retention) // anorexia?

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10
Q

what is high output cardiac failure

A

heart working normally but cannot meet bodies metabolic needs

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11
Q

causes high output HF

A

anaemia // AV malformation // Pagets // pregnancy // wet beri-beri (thiamine def)

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12
Q

symptoms chronic HF

A

dyspnoea // cough, worse at night // pink sputum // wheeze // weight loss // RSHF: raised JVP. ankle oedema

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13
Q

first line invx HF

A

proBNP blood tests

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14
Q

if high levels of BNP what test is done next in HF

A

high –> echo 2 weeks // raised –> echo 6 weeks

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15
Q

1st line mx chronic HF

A

ACEi + BB

16
Q

2nd line mx HF

A

aldosterone antagonist eg spironolactone

17
Q

what needs to be monitored if on ACEi + aldosterone antagonist

A

hyperkalaemia

18
Q

what drug may be used 2nd line in HF with reduced ejection fracture (<45%)

A

SGLT2i eg dapagliflozin

19
Q

when would ivabradine be indicated in chronic HF

A

3rd line if rhythm >75 and LV fraction <35%

20
Q

when would sacubitril-valsartan be indicated in chronic HF

A

3rd line if LV fraction <35% (ACEi + BB washout prior)

21
Q

when would digoxin be indicated in chronic HF

A

3rd line, maybe if patient has AF

22
Q

when would hydralazine be indicated in chronic HF + what is it given with

A

3rd line in afro-carribean + nitrates

23
Q

when would cardiac resynchronisation be indicated in chronic HF

A

wide QRS eg LBBB

24
Q

3rd line mx chronic HF

A

ivabradine, sacubriril-valsartan, digoxin, hydralazine + nitrates, cardiac resynchronisation

25
Q

what vaccines do patients on HF need

A

annual influenza + one of pneumococcal

26
Q

what drug can be given for fluid overload in HF and what effect does this have on prognosis

A

loop diuretics - no effect on mortality

27
Q

what classification defines severity of HF and what are the classes

A

NYHA: 1–>4, no symptoms –> slight limited activity –> moderate limited –> severe

28
Q

what can cause de-novo acute HF

A

ischamia // viral myopathy // toxin // valve dysfunction

29
Q

what can cause acute HF

A

ACS // hypertension // arrhthmia // valves

30
Q

presentation acute HF

A

SOB // cyanosis // raised JVP // oedema // reduced exercise // JVP // crackles + wheeze // S3 heart sound

31
Q

invx acute HF

A

FBC // CXR // ECHO // BNP

32
Q

what treatment should all patients with acute HF get

A

IV loop diuretic

33
Q

when are nitrates given in acute HF (3)

A

if there is ischaemia, hypertension, valve disease

34
Q

what ventilation do patients with acute HF + resp failure receive

A

CPAP

35
Q

what mx can be given in acute HF + low BP (cardiogenic shock) (3)

A

inotropic agents eg dobutamine // vasopressors eg norepinephrine // devices