Heart failure Flashcards
how is left ventricular ejection fraction (LVEF) measured
echo
how much does LVEF need to be reduced to be termed HF with reduced ejection fraction (HF-rEF)
35-40%
how does HF-rEF and HF-pEF related to systole and diastole
HF-rEF is usually problem with systole + contraction // HF-pEF is usually problem with diastole + filling
what can cause systolic dysfunction
IHD // dilated cardioyopathy // myocarditis // arrythmia
what can cause diastolic dysfunction
HCOM // restrictive cardiomyopathy // tamponade // contrictive pericarditis
what side of the heart does HF-rEF and HF-pEF cause failure of
left
what side of the heart does HF-rEF and HF-pEF cause failure of
left
what can cause right sided HF
increased RV afterload (pulm hypertension) // increased right ventricular preload (tricuspid regurg)
symptoms LV HF
pulmonary oedea - dyspnoea, orthopnoea, nocturnal dypnosea, basal fine crackles
symptoms RV HF
periphal oedema // raised JVP // hepatomegaly // weight gain (fluid retention) // anorexia?
what is high output cardiac failure
heart working normally but cannot meet bodies metabolic needs
causes high output HF
anaemia // AV malformation // Pagets // pregnancy // wet beri-beri (thiamine def)
symptoms chronic HF
dyspnoea // cough, worse at night // pink sputum // wheeze // weight loss // RSHF: raised JVP. ankle oedema
first line invx HF
proBNP blood tests
if high levels of BNP what test is done next in HF
high –> echo 2 weeks // raised –> echo 6 weeks
1st line mx chronic HF
ACEi + BB
2nd line mx HF
aldosterone antagonist eg spironolactone
what needs to be monitored if on ACEi + aldosterone antagonist
hyperkalaemia
what drug may be used 2nd line in HF with reduced ejection fracture (<45%)
SGLT2i eg dapagliflozin
when would ivabradine be indicated in chronic HF
3rd line if rhythm >75 and LV fraction <35%
when would sacubitril-valsartan be indicated in chronic HF
3rd line if LV fraction <35% (ACEi + BB washout prior)
when would digoxin be indicated in chronic HF
3rd line, maybe if patient has AF
when would hydralazine be indicated in chronic HF + what is it given with
3rd line in afro-carribean + nitrates
when would cardiac resynchronisation be indicated in chronic HF
wide QRS eg LBBB
3rd line mx chronic HF
ivabradine, sacubriril-valsartan, digoxin, hydralazine + nitrates, cardiac resynchronisation
what vaccines do patients on HF need
annual influenza + one of pneumococcal
what drug can be given for fluid overload in HF and what effect does this have on prognosis
loop diuretics - no effect on mortality
what classification defines severity of HF and what are the classes
NYHA: 1–>4, no symptoms –> slight limited activity –> moderate limited –> severe
what can cause de-novo acute HF
ischamia // viral myopathy // toxin // valve dysfunction
what can cause acute HF
ACS // hypertension // arrhthmia // valves
presentation acute HF
SOB // cyanosis // raised JVP // oedema // reduced exercise // JVP // crackles + wheeze // S3 heart sound
invx acute HF
FBC // CXR // ECHO // BNP
what treatment should all patients with acute HF get
IV loop diuretic
when are nitrates given in acute HF (3)
if there is ischaemia, hypertension, valve disease
what ventilation do patients with acute HF + resp failure receive
CPAP
what mx can be given in acute HF + low BP (cardiogenic shock) (3)
inotropic agents eg dobutamine // vasopressors eg norepinephrine // devices
