Heart Failure Flashcards
Given a general definition for heart failure.
“A clinical syndrome comprising of dyspnoea, fatigue or fluid retention due to cardiac dysfunction, either at rest or on exertion, with accompanying neurohormonal activation.”
Heart failure is not the final diagnosis- how can it be qualified?
By the underlying structural abnormality
For example, heart failure due to left ventricular systolic dysfunction due to ischemic heart disease
What are some of the risks/ conditions which can increase risks of heart failure?
Increasing age
Diabetes
Hypertension
COPD
Obesity
In those with conditions which can increase chances of heart failure, how can these risks be reduced?
Treatment of the underlying condition
What are some of the initial symptoms of heart failure?
Breathlessness
Fatigue
Oedema
Reduced exercise capability
What are some of the initial clinical signs which may be suggestive of heart failure?
Oedema
Tachycardia
Raised JVP
Chest crepitations or effusions
3rd heart sound
Displaced or abnormal apex beat
Which investigation can help to diagnose heart failure and why?
Chest x-ray
Can show gross cardiomegaly and pleural effusions and oedema
According to the European soc cardiology guidelines, what are the three factors a patient must have in order to be diagnosed with heart failure?
- Symptoms/signs of HF, either at rest or upon exercise
- Objective evidence of cardiac dysfunction
- Responds to diuretics (this one is only important when unsure about making a diagnosis)
How can objective evidence be obtained when diagnosing someone with HF?
Using the following investigations-
-Echocardiography
-Radionuclide ventriculography
-MRI
-Left ventriculography
What are the two potential ‘screening’ tests used for HF?
->note ‘screening’ as other investigations can have a low waiting list so these are used to get an idea more quickly
12 Lead ECG
BNP- blood test that measures levels of a protein called BNP
Why is a 12 lead ECG an effective screening process?
If there are no abnormalities on the ECG, patient is very unlikely to have heart failure.
What level of BNP is consistent with HF?
Elevated BNP
Which test is considered to be the first line test for patients with suspected HF?
BNP blood test
The higher the levels of BNP,….?
The more advanced HF is
Which structural abnormalities can cause HF?
Pretty much any structural/ functional cardiac abnormalities.
Here’s a few-
LV systolic dysfunction
Valvular heart disease
Pericardial constriction or effusion
LV diastolic dysfunction/heart failure with preserved systolic function/heart failure with normal ejection fraction
Cardiac arrhythmias: tachy or brady
Myocardial ischaemia/infarction (usually via LVSD)
Restrictive cardiomyopathy eg amyloid, HCM
Right ventricular failure: primary or secondary to pul hypertension
What are the two main groups of causes of LV systolic disfunction?
Ischaemic heart diseases, usually MI
Dilated cardiomyopathy
What is dilated cardiomyopathy?
An umbrella term covering left ventricular systolic dysfunction that is not due to ischaemic heart disease or primary valve lesion.
What investigations are carried out to diagnose LV systolic dysfunction?
ECG
CXR
ECHO
Which investigation is ALWAYS carried out when diagnosing LV systolic dysfunctions?
ECHO
When would it be especially important to consider coronary angiography in patients with suspected LV systolic dysfunction?
If they have chest pain- especially if younger
Why might CT coronary angiogram be considered instead of cor angio?
Less invasive as does require insertion of a catheter
What is one way of assessing how damaged the left ventricle is?
Assessing the left ventricular ejection fraction
Is LV ejection fraction a continuous or discrete biological variable?
Continuous
What is one issue with using LV ejection fraction to assess damage to the left ventricle?
Cannot be sure of the normal value for the patient.
A high/low level could be normal for them
What is a normal LVEF % approx?
55-70%
What is a mild LVEF % approx?
40-55%`
What is a moderate LVEF % approx?
30-40%
What is a severe LVEF % approx?
<30%
What scan is an accurate way of getting a LVEF measurement?
MUGA scan
Is Cardiac MRI more accurate than ECHO?
Yes
What are the disadvantages of cardiac MRI even though it’s more accurate?
-Expensive, time-consuming
-Cannot be done at bedside
-Requires breathholding
-Claustrophobia issues
What does grading of HR with the New York Association for HF take into account?
Looks at symtoms
What would a NYHA* classification of 1 suggest?
*New York Association
No symptoms during usual acitivty
What would a NYHA* classification of 2 suggest?
*New York Association
Comfortable with rest or mild exertion
What would a NYHA* classification of 3 suggest?
*New York Association
Comfortable only at rest
What would a NYHA* classification of 4 suggest?
*New York Association
Any physical activity brings on discomfort
Symptoms occur at rest
