Heart Failure Flashcards
describe heart failure with preserved/ reduced EF
Reduced EF: <50%
Preserved EF <50%
This is the result of diastolic dysfunction, where there is an issue with the left ventricle filling with blood during diastole (the ventricle relaxing).
causes of heart failure
Ischaemic heart disease
Valvular heart disease (commonly aortic stenosis)
Hypertension
Arrhythmias (commonly atrial fibrillation)
Cardiomyopathy
symptoms of left and right HF
Left HF: PND, orthopnoea, chronic cough, fatigue
Right HF: peripheral oedema raised JVP, smooth enlarged liver, ascites
what signs might you find on examination of a patient with HF
Tachycardia
Tachypnoea
Hypertension
Murmurs on auscultation
Bilateral basal crackles
Raised jugular venous pressure
Peripheral oedema
what classification can be used to assess the severity of HF symptoms
New York Heart Association (NYHA)
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
how can you investigate for HF
ECG
NT‑proBNP blood test (>2000 urgent ref)
Bloods: FBC, Us+Es, TFTs, LFTs, lipids and diabetes
Chest x-ray and lung function tests to exclude lung pathology
Echocardiogram
what are the five principles of management for HF
R – Refer to cardiology
A – Advise them about the condition
M – Medical treatment
P – Procedural or surgical interventions
S – Specialist heart failure MDT input, such as the heart failure specialist nurses, for advice and support
what additional management can be done in HF patients
Flu, covid and pneumococcal vaccines
Stop smoking
Optimise treatment of co-morbidities
Written care plan
Cardiac rehabilitation
what is first line medical management for HF patients
A – ACE inhibitor
B – Beta blocker
A – Aldosterone antagonist when symptoms are not controlled with A and B
L – Loop diuretics (e.g., furosemide or bumetanide)
if a patient has valvular heart disease and HF which medication should be avoided unless started by a specialist
ACEis
when can Implantable cardioverter defibrillators be used in the treatment of HF
patients who previously had ventricular tachycardia or ventricular fibrillation.
when can Cardiac resynchronisation therapy (CRT) be used in treatment of HF
severe heart failure, with an ejection fraction of less than 35%
helps optimise heart function
what is cor pulmonale
HF + chronic lung disease
lung disease causes constriction of the pulmonary arterioles which leads to increased pulmonary pressure and RV hypertrophy
