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Cardiorespiratory > Heart failure > Flashcards

Heart failure Flashcards

1
Q

Which beta blockers are recommended for chronic heart failure?

A

Carvedilol and bisoprolol.

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2
Q

What is cardiac output?

A

The volume of blood ejected by the heart per minute.
HR x SV

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3
Q

What is stroke volume?

A

The volume of blood ejected during each beat/contraction.

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4
Q

An 85 year old patient with chronic kidney disease and aortic stenosis is prescribed 2 litres of fluid over 4 hours and then starts to drop her oxygen saturation. What is the likely diagnosis and how would you manage her?

A

Acute LVF and IV furosemide.

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5
Q

Define ejection fraction

A

The percentage of blood in the left ventricle that is squeezed out with each ventricular contraction.

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6
Q

Define preload

A

Stretching of cardiomyocytes at the end of diastole. Ventricular filling pressure.

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7
Q

Define afterload

A

Pressure or load against which the ventricles must contract. How hard heart pumps against resistance.

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8
Q

Define inotropy

A

Myocardial contractility.

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9
Q

What is the Frank-Starling law?

A

The relationship between ventricular stretching and contractility. Stretching of cardiac muscle (within physiological limits) will increase the force of contraction.

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10
Q

Define end diastolic volume (EDV)

A

Amount of blood in ventricles before contraction.

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11
Q

If EDV increases what happens to SV?

A

SV increases due to increase in preload therefore increasing contractility.

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12
Q

Define end systolic volume (ESV)

A

Amount of blood remaining in the ventricle after contraction.

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13
Q

If ESV increases what happens to SV?

A

SV decreases because there is more blood left in ventricles.

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14
Q

If afterload increases what happens to SV?

A

SV decreases and ESV increases.

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15
Q

How do you calculate SV?

A

EDV-ESV

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16
Q

What factor influences EDV?

A

Preload

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17
Q

Which factors influence ESV?

A

Contractility and afterload

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18
Q

Why should you monitor U&Es closely in patients taking diuretics, ACEi and aldosterone antagonists?

A

Diuretics can cause hypokalaemia.
ACEi and aldosterone antagonists can cause hyperkalaemia.

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19
Q

MOA of digoxin?

A

Inhibits Na+/K+ pump increasing intracellular Ca2+ which has a positive inotropic effect. It also increases vagal activity having a negative chronotropic effect.

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20
Q

Should calcium channel blockers be used in HF?

A

No

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21
Q

What causes pulmonary oedema in HF?

A

Backlog of blood in LA, pulmonary veins and lungs increases the volume and pressure, causing interstitial fluid leak into lungs and alveoli. Resulting in SOB and reduced O2%.

22
Q

Name some potential triggers for acute LV failure

A

Iatrogenic (e.g. aggressive fluids in elderly patient with impaired LV function), MI, arrhythmias, sepsis and hypertensive emergency.

23
Q

Describe the symptoms of acute LVF

A

Acute SOB, fatigue, orthopnoea, cough with white/pink sputum.

24
Q

Describe the signs of acute LVF

A

Tachypnoea, type 1 respiratory failure, tachycardia, bilateral basal coarse crackles.

25
Q

What are the signs of right sided heart failure?

A

Raised JVP, peripheral oedema, ascites, hepatomegaly.

26
Q

What blood test is used for HF?

A

Pro-BNP

27
Q

When is BNP normally released?

A

Hormone released from ventricles when myocardium is stretched and heart is overloaded.

28
Q

What is a normal EF?

A

> 55%

29
Q

Describe the management plan for acute LVF

A

Sit patient up.
Oxygen if sats are low.
Diuretics - IV furosemide.
IV fluids stopped.
Underlying causes identified and treated.
Monitor fluid balance.

30
Q

In severe cases what drugs would you use to manage acute LVF?

A

Dobutamine (inotrope), noradrenaline (vasopressor).

31
Q

What is chronic HF?

A

The clinical features of impaired cardiac function, specifically LV dysfunction.

32
Q

What is HF with reduced EF?

A

EF < 50%

33
Q

What is HF with preserved EF?

A

Clinical features of HF but an EF > 50%

34
Q

What are the most common causes of chronic HF?

A

IHD and hypertension.

35
Q

Describe the compensatory mechanism for a reduced CO in HF

A

Increasing preload, increasing HR, activation of RAAS system, activation of sympathetic NS.

36
Q

Describe the symptoms of chronic HF

A

SOB, cough with pink/white frothy sputum, orthopnoea, PND, peripheral oedema, fatigue.

37
Q

Describe the signs of chronic HF

A

Tachycardia, tachypnoea, hypertension, S3/4 heart sounds, bilateral basal coarse crackles, raised JVP, peripheral oedema, displaced apex beat, hepatomegaly and ascites.

38
Q

Describe the CXR findings for chronic HF

A

Alveolar opacification/oedema.
Kerley B lines.
Cardiomegaly.
Dilated upper lobe vessels.
Pleural effusions.

39
Q

How would you confirm HF?

A

Echocardiogram

40
Q

Describe the NYHA classification of HF

A

Class 1: no limitation on activity.
Class 2: comfortable at rest but symptomatic with ordinary activities.
Class 3: comfortable at rest but symptomatic at any activity.
Class 4: symptomatic at rest.

41
Q

Which vaccines would you offer to a patient with chronic HF?

A

Annual flu, pneumococcal and COVID vaccines

42
Q

What are the first line medications for chronic HF?

A

ACEi and beta blocker.

43
Q

What medication would you add on if reduced EF HF wasn’t controlled by ACEi or beta blocker?

A

Aldosterone antagonist e.g. spironolactone or eplerenone.

44
Q

What medication would you use for preserved EF HF or fluid overload?

A

Loop diuretic e.g. furosemide.

45
Q

What type of pacemaker is used for HF and at what EF?

A

EF < 35% and cardiac resynchronisation therapy (CRT) - biventricular pacing.

46
Q

Where is the site of action of furosemide?

A

Inhibits the Na-K-Cl cotransporter in the thick ascending limb of the loop of Henle.

47
Q

Which drug should be considered for Afro-Caribbean patients with HF who are not responding to ACE-inhibitor, beta-blocker and aldosterone antagonist therapy?

A

Hydrazine and nitrate

48
Q

Which drugs are contraindicated in moderate-severe aortic stenosis?

A

ACEi, GTN, ARBs, dihydropyridine CCB, hydralazine - due to the vasodilatory effect.

49
Q

How can NSAIDs worsen HF?

A

They reduce renal sodium excretion and can cause fluid retention.

50
Q

How can Verapamil worsen HF?

A

Negative inotropic effect

Cardiorespiratory (15 decks)

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