Heart Failure Flashcards
What is meant by SYSTOLIC failure? What causes this?
Ventricles cant contract
reduced cardiac output
EF <40%
Causes:
- IHD
- MI
- cardiomyopathy
What is meant by DIASTOLIC failure? Name some causes
Ventricles cant relax
Increased filling pressures
EF >50% (HFpEF - heart failure with preserved ejection fraction)
Causes:
- LVH
- constrictive pericarditis
- tamponade
- restrictive cardiomyopathy
- obesity
Symptoms of LEFT VENTRICULAR (LV) failure
SOBOE
Fatigue
Orthopnoea
PND
Nocturnal Cough (pink frothy sputum)
Wheeze
Nocturia
Cold peripheries
Symptoms of RIGHT VENTRICULAR (RV) Failure
Peripheral oedema
ascites
nausea
anorexia
facial engorgement
epistaxis
What causes RV failure?
LV failure
pulmonary stenosis
cor pulmonale
Why do patient become symptomatic with low output heart failure?
The cardiac output fails to increase on exertion
What is responsible for low output heart failure?
Increased PRELOAD
- mitral regurg.
- fluid overload
=> ventricular dilatation
=> ventricle cant contract
=> SYSTOLIC failure
Increased AFTERLOAD (push against increased pressure)
- aortic stenosis
- hypertension
=> thickens ventricular muscle
=> ventricle cant relax
=> DIASTOLIC failure
CXR signs of pulmonary oedema
A - alveolar bat wing (perihilar alveolar oedema)
B - Kerley “B” Lines (interstitial oedema)
C - cardiomegaly
D - Dilated/prominent upper lobe blood vessels
E - Effusions
Management of acute pulmonary oedema
Sit patient upright
High flow O2
Treat any arrhythmias
Furosemide IV
Name at least 3 drugs used in te long term management of heart failure
Diuretics
- Furosemide/Bumetanide
- if low K+ - use spironolactone
- if refractory oedema, add thiazide
ACEi
- for LVSD
- if cough, swap to ARB
Beta Blocker
- reduces mortality
- start low, go slow
- >2 weeks between increasing doses
Spironolactone/Eplerenone
- if symptomatic despite optimal Tx
- Post MI LVSD
- reduces mortality by 30%
Digoxin
- can be used as adjunct even if patient is in SR
Hydralazine + Isosorbide Dinitrate if intolerant of ACEi/ARB
