Heart failure Flashcards
What is meant by heart failure?
This is a state in which the heart is unable to pump blood at a rate commensurate with the requirements of tissue, or can only do so at high pressure
What is meant by HF-pEF?
Heart Failure with preserves Ejection Fraction
What is meant by HF-rEF?
Heart Failure with reduced Ejection Fraction
What is ejection fraction?
This is the percentage of blood that is pumped out of the heart during each beat
What is considered to be a normal ejection fraction?
≥50%
What is meant by a reduced ejection fraction in heart failure?
≤40%
What are some conditions that can cause systolic dysfunction in heart failure?
Arrhythmia
Myocarditis
Dilated cardiomyopathy
Ischaemic heart disease
What are some conditions that can cause diastolic dysfunction in heart failure?
Hypertrophic Obstructive Cardiomyopathy
Restrictive cardiomyopathy
Cardiac tamponade
Constrictive pericarditis
What are some core symptoms in heart failure?
Dyspnoea
Cough
Paroxysmal Nocturnal Dyspnoea
Orthopnoea
Fatigue
Peripheral oedema
What sided heart failure will usually cause pulmonary oedema?
Left - Lungs
What sided heart failure will usually cause peripheral oedema?
Right - Rest of body
How is the effect of heart failure on physical activity classified?
New York Heart Association Classification:
I - No limitation to physical activity
II - Slight limitation to physical activity
III - Marked limitation of physical activity
IV - Unable to carry out physical activity
What are some clinical signs of heart failure?
Elevated JVP
Tachycardia
Cardiomegaly
S3 and S4 heart sounds
Bi-basal crackles
Ascites
Tender hepatomegaly
Ankle oedema
What are some symptoms more suggestive of left sided heart failure?
pulmonary oedema:
dyspnoea
orthopnoea
paroxysmal nocturnal dyspnoea
bibasal fine crackles
What are some symptoms more suggestive of right sided heart failure?
peripheral oedema
ankle/sacral oedema
raised jugular venous pressure
hepatomegaly
weight gain due to fluid retention
anorexia (‘cardiac cachexia’)
What are some ways in which the body can initially compensate for heart failure?
Increased adrenergic activity, therefore increasing heart rate, blood pressure and cardiac contractility
Increased angiotensin II production, causing vasoconstriction and thus increasing afterload
Increased aldosterone production therefore causing water retention and thus increasing blood pressure
Secretion of BNP, which works to decrease blood pressure if strain is too high on the heart
What investigations are required in heart failure?
History and examination
NT-Pro-BNP testing
ECG
Echocardiogram
Bloods
CXR
What is the NT-pro-BNP test useful for?
It has a high sensitivity but a low specificity, so can be used to rule out those who do not have heart failure
What are the 5 stages of management of a patient with heart failure? (RAMPS)
R - Refer to cardiology
A - Advise about condition
M - Medical treatment
P - Procedural or surgical intervention
S - Specialist MDT input
What is the first line pharmacological treatment in HF-pEF?
Loop diuretics (e.g. furosemide)
What are the 4 main drugs used in treatment of HF-rEF?
A - ACEi or ARB
B - ß-Blockers
A - Aldosterone antagonist
L - Loop diuretic
What are some 2nd line drugs that can be trialled in HF-rEF?
HCN channel blocker - Ivabradine
Angiotensin Receptor Neprilysin Inhibitor (ARNI) - Salcubatril valsartan
Vasodilator - Hyralazine
SGLT2 inhibitors - Dapagliflozin
Digoxin
How is acute heart failure first treated?
L - Loop diuretic IV
M - Morphine IV
N - Nitrates
O - Oxygen
P - Position sitting up
What is the effect of an ARNI (e.g. salcubatril valsartan)?
This decreases blood pressure, sympathetic tones and aldosterone levels, while enhancing the effects of natriuretic peptides
What are some lifestyle management techniques that should be used in heart failure?
Exercise-based rehabilitation
Reduce fluid intake
Reduce salt intake
Keep vaccinations up to date
Manage mental health
How will heart failure present on chest x-ray?
What are some possible complications of heart failure?
Arrythmias - most commonly AF and ventricular arrhythmias
Depression
Cachexia
Chronic kidney disease
Sudden cardiac death
