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Cardiology > Heart failure > Flashcards

Heart failure Flashcards

1
Q

triggers of acute left ventricular failure?

A

iatrogenic (aggressive IV fluids in elderly with impaired left ventricular function)
MI
arrhythmias
sepsis
hypertensive emergency

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2
Q

Acute LVF causes?

A

type 1 respiratory failure, low oxygen without an increase in carbon dioxide

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3
Q

symptoms of lvf?

A

sob, looking unwell, cough with frothy white or pink sputum, sob worse when lying flat

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4
Q

signs of acute lvf?

A

tachycardia, raised resp rate, reduced oxygen sats, 3rd heart sound, bilateral basal crackles, hypotension, displaced apexbeat, cyanosis, elevated jvp

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5
Q

in right sided heart failure you would find?

A

raised jvp, peripheral oedema

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6
Q

why is BNP released?

A

released from ventricles when myocardium is stretched beyond the normal range.

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7
Q

action of BNP?

A

relax smooth muscle in blood vessels, diuretic to promote water excretion

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8
Q

BNP can be raised?

A

heart failure. >100mg/l
tachycardia
sepsis
PE
renal impairment
COPD

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9
Q

CXR for heart failure?

A

cardiomegaly >0.5
upper lobe venous diversion - increased diameter
bilateral pleural effusions
interlobar fissures fluid
kerley lines

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10
Q

management of acute LVF?

A

sit up
oxygen
diuretics iv furosemide
IV fluids stopped
underlying causes
monitor fluid balance

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11
Q

severe cases of LVF require?

A

Intravenous opiates, such as morphine, which act as vasodilators
Intravenous nitrates act as vasodilators, and may be considered in severe hypertension or acute coronary syndrome
Inotropes, such as dobutamine, to improve cardiac output
Vasopressors, such as noradrenalin, to improve blood pressure
Non‑invasive ventilation
Invasive ventilation (involving intubation and sedation)

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12
Q

de-novo heart failure is caused by?

A

increased cardiac filling pressures and myocardial dysfunction, due to ischaemia. this will cause reduced cardiac output and hypoperfusion, which will result in pulmonary oedema. other causes are viral myopathy, toxins, valve dysfunction

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13
Q

causes of decompensated heart failure?

A

ACS, acute arrhythmia, hypertensive crisis, valvular disease

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14
Q

when not to give vasodilators?

A

hypotension

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15
Q

when do vasodilators have a role?

A

concomitant myocardial ischaemia, sever hypertension, regurgitant aortic or mitral valve disease

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16
Q

how should patients with respiratory failure be treated?

A

CPAP

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17
Q

How to treat patients with cardiogenic shock, hypotension <85mmHg?

A

inotropic agents dobutamine (severe left ventricular dysfunction), vasopressor agents norepinephrine (if ionotropes dont work/ end organ hypoperfusion, mechanical circulatory assisstance intra aortic balloon counterpulsation

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18
Q

when should beta blockers be stopped in heart failure?

A

less than 50 beats per minute, second or 3rd degree atrioventricular block, shock

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19
Q

heart failure with reduced LVEF is?

A

<35 to 40%

20
Q

usually people with HF-rEF have?

A

systolic dysfunction whereas HF-pEF have diastolic dysfunction

21
Q

systolic dysfunction is?

A

ischaemic heart disease
dilated cardiomyopathy
myocarditis
arrhythmia

22
Q

diastolic dysfunction is due to?

A

hypertrophic obstructive cardiomyopathy
restrictive cardiomyopathy
cardiac tamponade
constrictive pericarditis

23
Q

left ventricular failure results in?

A

pulmonary oedema, dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, bibasal fine crackles.

24
Q

right ventricular failure results in?

A

peripheral oedema
raised jvp
hepatomegaly
anorexia
weight gain

25
Q

what is high output heart failure?

A

normal heart unable to pump enough blood to metabolic needs

causes: pregnancy, thyrotoxicosis, thiamine deficiency, pagets disease, arteriovenous malformation, anaemia

26
Q

causes of chronic heart failure?

A

ischaemic heart disease, valvular heart disease (aortic stenosis), HTN, arrhythmia, cardiomyopathy

27
Q

presentation of chronic heart failure?

A

Breathlessness, worsened by exertion
Cough, which may produce frothy white/pink sputum
Orthopnoea, which is breathlessness when lying flat, relieved by sitting or standing (ask how many pillows they use)
Paroxysmal nocturnal dyspnoea (more detail below)
Peripheral oedema
Fatigue

28
Q

examination signs of chronic heart failure

A

tachycardia (raised heart rate)
Tachypnoea (raised respiratory rate)
Hypertension
Murmurs on auscultation indicating valvular heart disease
3rd heart sound on auscultation
Bilateral basal crackles (sounding “wet”) on auscultation of the lungs, indicating pulmonary oedema
Raised jugular venous pressure (JVP), caused by a backlog on the right side of the heart, leading to an engorged internal jugular vein in the neck
Peripheral oedema of the ankles, legs and sacrum

29
Q

mechanisms of paroxysmal nocturnal dyspnoea?

A
  1. fluid settles over large surface area causing breathlessness
  2. respiratory centre less responsive, decreased resp rate - pulmonary congestion and hypoxia
  3. less adrenalin- myocardium is relaxed, reduced output
30
Q

New York Heart Association classification?

A

Class I: No limitation on activity
Class II: Comfortable at rest but symptomatic with ordinary activities
Class III: Comfortable at rest but symptomatic with any activity
Class IV: Symptomatic at rest

31
Q

referral to specialists depends on NT-proBNP?

A

400-2000ng/l- echo within 6 weeks
above 2000ng/l- echo within 2 weeks

32
Q

First line for chronic heart failure?

A

ABAL
ACEi ramipril/ ARB
Beta blocker bisoprolol
Aldosterone antagonist when symtpoms not controlled with A/B spironolacotone/eplerenone
Loop diuretics- furosemids/bumetanide

33
Q

avoid ACEi in?

A

valvular heart disease

34
Q

what cause electrolyte disturbances?

A

diuretics, aldosterone antagonist, ACEi

35
Q

ACEi and aldosterone anatagonist cause?

A

hyperkalaemia

36
Q

specialist treatment for HF?

A

SGLT2 inhibitor (e.g., dapagliflozin)
Sacubitril with valsartan (brand name Entresto)
Ivabradine
Hydralazine with a nitrate
Digoxin

37
Q

implanatbale cardioverter defibrillators are used for?

A

shockable rhythms, ventricular tachycardia/ fibrillation previously

38
Q

cardiac resynchronisation therapy?

A

EF less than 35%- biventricular triple chambers pacemaker

39
Q

in chronic heart failure first line is always?

A

ACEi and BB

40
Q

pneumococcal vaccine for those with asplenia, splenic dysfunction or CKD?

A

booster every 5 years

41
Q

3rd line therapy for chronic heart failure?

A

ivabradine, sacubitril-valsartan, hydralazine in combination with nitrate, digoxin and cardiac resynchronisation therapy

42
Q

criteria for ivabradine?

A

sinus rhythm>75/min LEVF less than 35

43
Q

sacubitril valsartan criteria?

A

criteria: left ventricular fraction < 35%
is considered in heart failure with reduced ejection fraction who are symptomatic on ACE inhibitors or ARBs
should be initiated following ACEi or ARB wash-out period

44
Q

digoxin is strongly indicated if?

A

coexistent AF

45
Q

CRT indicated in

A

widened QRS left bundle branch block

46
Q

hydralazine with nitrate in?

A

afro-carribean patients

Cardiology (14 decks)

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