Heart failure Flashcards
What is heart failure?
A state in which the heart is unable to pump blood at a rate sufficient to meet the requirements of the tissue, or can only do so at high pressure
What is meant by HFpEF?
Heart failure with preserved ejection fraction
What is meant by HFrEF?
Heart failure with reduced ejection fraction
What are some causes of heart failure?
Coronary artery disease
Hypertension
Dilated cardiomyopathy (hereditary, alcohol or chemo)
Valve disease
Tachycardia arrhythmia
What are some symptoms of heart failure?
Shortness of breath
Orthopnoea
Paroxysmal Nocturnal dyspnoea
Reduced exercise tolerance
Fatigue
Tiredness
Ankle oedema
What are the New York Heart Association Classes of heart failure?
Type I - No limitation to physical activity
Type II - Slight limitation to physical activity
Type III - Marked limitation to physical activity
Type IV - Unable to carry out physical activity
What examinations should be performed to diagnose heart failure?
JVP examination
Auscultation of lungs and heart
Leg and sacrum exam for oedema
ECG
Chest X-ray
Transthoracic echocardiography
BNP test
cardiac MRI
What can be seen on a chest X-ray in heart failure?
Perihilar congestion
Enlarged cardiac silhouette
Kerley B lines (Horizontal white lines)
What can be shown by transthoracic echocardiography?
Chamber size
Chamber function
Abnormalities
Stiffness
Valvular disease
Disease of the pericardium
Ejection fraction
What is ejection fraction?
The percentage of blood that os pumped out of the heart during each beat
What is a normal ejection fraction?
≥50%
What ejection fraction is classified as HFrEF?
≤40%
What is the significance of B Natriuretic Peptides and NT pro-BNP?
These are released by the ventricles the under stress
The test can only rule out those who DO NOT have heart failure, but can’t diagnose those who do
What are some lifestyle modifications that can be made to help in heart failure?
Exercise-based rehabilitation
Restriction of fluid intake
Restriction of salt intake
Keeping vaccines (especially Flu and Pneumococcal) up to date
Managing mental health
What drugs can be used in the treatment of heart failure?
ACEi or ARBs
ß-Blockers
Aldosterone antagonists
Loop diuretics
SGLT2 inhibitors - Dapagliflozin
Angiotensin Receptor Neprilysin inhibitors - e.g. salcubatril valsartan
Ivabridine
Digoxin
