Heart Failure Flashcards
What is heart failure?
A clinical syndrome, comprising of dyspnoea, fatigue, or fluid retention - due to cardiac dysfunction (structural/functional abnormalities) - at rest or on exertion, with accompanying neurohormonal activation.
What is the prevalence and prognosis of heart failure?
Prevalence is increasing - more cases of hypertension, obesity, diabetes and CHD.
Prognosis - 1YS rate is worse than breast, uterus, prostate, and bladder cancer.
What is the burden of heart disease?
~2wk avg hospital admission length.
Longer than breast and lung cancer.
High readmission rates (often within 1wk).
What are the symptoms of heart failure?
SOB and fatigue (non-specific).
Reduced exercise capacity.
What are the signs of heart failure?
Crackles, oedema, tachycardia (non-specific).
HS3, raised JV, displaced/abnormal apex beat (insensitive).
What is the diagnosis of heart failure?
Incorrect in 50% of cases.
Considers symptoms and signs.
Objective evidence of cardiac dysfunction (ECHO, RNVG/MUGA, MRI).
What is the interpretation of an ECG of heart failure?
If entirely normal - LVSD is unlikely.
Problem - interpretation confidence.
What is the interpretation of BNP of heart failure?
Low - excludes HF/LVSD.
High - indicates ECHO or cardiac assessment.
Recommended first-line test in suspected HF.
A predictor or mortality and morbidity.
Can test at bedside; cheap.
How is heart failure classified?
NYHA:
I - no exercise limit or symptoms.
II - mild exercise limit, symptoms on exertion.
III - moderate exercise limit, only comfortable at rest.
IV - severe exercise limit, discomfort at rest.
Also considers LV impairment and BNP elevation.
What is the neurohormonal hypothesis of heart failure?
RAAS - LV hypertrophy/remodelling and fibrosis; hypokalaemia and hypomagnesaemia.
SNS - arrhythmogenic.
What are the causes of LVSD?
MI, severe aortic valve disease or MR.
Dilated cardiomyopathy - not due to IHD/VSD (inherited, toxins, acute myocarditis, HIV, hypertension).
What is the diagnosis of LVSD?
PMH - MI, DM, hypertension, post-partum.
FH - familial DCM.
SH - IVDU, alcohol abuse.
Exclude renal failure and anaemia.
Consider sarcoidosis and muscular dystrophy.
What is always done to investigate LVSD?
ECHO - for valvular/diastolic dysfunction, pericardial effusion, cardiac tamponade, LVH, CHD, hypertension (atrial dilatation).
May not identify constriction or shunts.
What are the investigations for LVSD?
ECG and CXR.
Coronary angiography or CT coronary angiogram - if chest pain or <70yrs old.
Revascularisation - if ischaemic.
Cardiac MRI - for infarction, inflammation, fibrosis.
Assessment from a cardiologist.
What is LVEF?
Changed by disease or physiology.
Analogous to Hb/anaemia.
Difficult to quantify accurately by ECHO.
