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Cardiovascular system > Heart failure > Flashcards

Heart failure Flashcards

1
Q

Typical heart failure symptoms

A

breathlessness
ankle swelling (peripheral oedema)
fatigue

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2
Q

Typical heart failure signs

A

elevated JVP
pulmonary crackles
peripheral oedema

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3
Q

What is the New York Heart Association (NYHA) functional classes?

A

classify severity of cardiovascular disability through severity of exertional dyspnoea or discomfort at rest

class 1 = no limitations on activity
class 2 = comfortable at rest, ordinary physical activity causes symptoms
class 3 = comfortable at rest, patients have marked limitation of physical activity
class 4 = patients have symptoms even at rest

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4
Q

How is ejection fraction calculated?

A

stroke volume = end-diastolic volume - end-systolic volume

ejection fraction = (stroke volume/end-diastolic volume)x100

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5
Q

What is HFpEF?

A

heart failure with preserved ejection fraction

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6
Q

Causes of HFpEF/diastolic heart failure

A

hypertension
diabetes
obesity
old age
restrictive cardiomyopathies (amyloidosis, HCM, Fabry’s)
HOCM
cardiac tamponade
restrictive pericarditis

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7
Q

Pathophysiology of HFpEF

A

impaired LV relaxation
increased LVEDP
reduced diastolic filling
reduced cardiac output

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8
Q

Causes of HFrEF

A

ischaemic heart disease (post-MI)
dilated cardiomyopathy
myocarditis
infiltration (eg. haemochromatosis or sarcoidosis)

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9
Q

What is HFrEF?

A

heart failure with reduced ejection fraction

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10
Q

What is heart failure and what can it also be called?

A

when the heart is unable to pump sufficiently to maintain blood flow to meet the body’s needs

congestive cardiac failure (CCF)
congestive heart failure (CHF)

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11
Q

Describe high output cardiac failure

A

cardiac output is normal but there is an increase in peripheral metabolic demands which exceed those that can be met with maximal cardiac output

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12
Q

Causes of high output cardiac failure

A

AAPPTT

anaemia
arteriovenous malformation
paget’s disease
pregnancy
thyrotoxicosis
thiamine deficiency

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13
Q

Clinical features of left heart failure

A

pulmonary congestion (pressure builds up behind the left heart)
systemic hypoperfusion (reduced left heart output)

NB Sometimes left sided heart failure can lead to pulmonary congestion which in turn also pushes the right ventricle into failure. In these cases signs and symptoms of both left and right sided heart failure may be present

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14
Q

Symptoms caused by pulmonary congestion

A

SOBOE
orthopnoea
paroxysmal nocturnal dyspnoea
nocturnal cough (+ pink frothy sputum)

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15
Q

Signs caused by pulmonary congestion

A

tachypnoea
bibasal fine crackles on lung auscultation

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16
Q

Signs caused by systemic hypoperfusion

A

cyanosis
prolonged capillary refill time
hypotension

17
Q

Less common signs of left heart failure

A

Pulsus alternans (alternating strong and weak pulse)
S3 gallop rhythm (produced by large amounts of blood striking a compliant left ventricle)
features of functional mitral regurgitation

18
Q

Clinical features of right heart failure

A

venous congestion (pressure builds up behind the right heart)
pulmonary hypoperfusion (reduced right heart output)

19
Q

Venous congestion symptoms

A

ankle swelling
weight gain
abdominal distension + discomfort
anorexia/nausea

20
Q

Venous congestion signs

A

raised JVP
pitting ankle/sacral oedema
tender smooth hepatomegaly
ascites
transudative pleural effusions (typically bilateral)

21
Q

Primary care investigations for heart failure

A

12 lead ECG
NTproBNP
Blood tests (FBC, U&E, LFTs, thiamine, B12/folate, vitamin D, calcium, magnesium, HbA1c)
CXR

22
Q

Secondary care investigations for heart failure

A

echocardiogram
cardiac MRI
invasive angiogram
cardiac CT coronary angiogram
nuclear imaging

23
Q

What is BNP released?

A

released by the ventricles in response to myocardial stretch

24
Q

What BNP level would warrant an urgent 2 week referral for a trans-thoracic echocardiogram?

A

> 2000
400-2000 = 6 week referral

25
Q

What % is considered reduced ejection fraction heart failure?

A

<40%
[>40% with raised BNP = HFpEF]

26
Q

Heart failure CXR findings

A

ABCDEF
Alveolar oedema
kerley B lines
Cardiomegaly
upper lobe blood Diversion
pleural Effusions
Fluid in horizontal fissure

27
Q

Heart failure lifestyle modifications

A

smoking cessation
salt and fluid restriction
supervised cardiac rehabilitation

28
Q

Pharmacological management of heart failure

A

ACE-i + B-blocker (improve mortality)
- ARB if intolerant to ACE-is
- hydralazine + nitrate if intolerant to ACE-i + ARB

Loop diuretics (eg. furosemide, bumetanide) - improve symptoms, not mortality

if symptoms persist and NYHA class 3/4 consider:
- aldosterone antagonists (eg. spironolactone, eplerenone) - improve mortality
- hydralazine + nitrate for afro-caribbean patients
- ivabradine if in sinus rhythm and impaired EF
- angiotensin receptor blocker

Digoxin - useful for those with AF, worsens mortality but improves morbidity

29
Q

What surgical/device management options are available for heart failure?

A

cardiac resynchronisation therapy
ICDs in certain circumstances

30
Q

Initial management of acute heart failure (pulmonary oedema)

A

sit patient up
oxygen therapy (normally aiming sats >94%)
IV furosemide 40mg or more (further doses as necessary) and close fluid balance (aim negative balance)
SC morphine

31
Q

Advanced management or acute heart failure (pulmonary oedema)

A

normally in HDU or ITU

CPAP (reduces hypoxia and helps to push fluid out of alveoli)
intubation + ventilation
furosemide infusion
dopamine infusion (inhibits sympathetic drive and therefore increases myocardial contractility)
intra-aortic balloon pump (if in cardiogenic shock)
ultrafiltration (if resistant to or contraindicated diuretics)

GTN infusion no longer routinely used in heart failure

32
Q

Adverse effects of beta-blockers

A

bradycardia
hypotension
fatigue
dizziness

33
Q

Adverse effects of ACE-inhibitors

A

hyperkalaemia
renal impairment
dry cough
lightheadedness
fatigue
GI disturbances
angioedema

34
Q

Adverse effects of spironolactone

A

hyperkalaemia
renal impairment
gynaecomastia
breast tenderness/hair growth in women
changes in libido

35
Q

Adverse effects of furosemide

A

hypotension
hyponatraemia
hypokalaemia

36
Q

Adverse effects of hydralazine/nitrate

A

headache
palpitation
flushing

37
Q

Adverse effects of digoxin

A

dizziness
blurred vision
GI disturbances

Cardiovascular system (33 decks)

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