heart failure

Question 1

what is HF

Answer 1

heart cant pump enough blood to meet metabolic demand, = decreased cardiac output

Question 2

what is EF

Answer 2

ejection fraction = how much blood ventricle pumps out in contraction

Question 3

HFw/REF

Answer 3

heart failure with reduced ejection fraction <40% ef means left ventricle impaired contraction

Question 4

hfw/pEF

Answer 4

hf with preservesd ef - impairedleft ventricular relaxation w/ evidence diastolic function

Question 5

normal EF

Answer 5

50-70%

Question 6

ef calc

Answer 6

total amount ejected/ total blood in ventricle x 100

Question 7

symptoms and risk

Answer 7

pink tinge cough froth, dyspnea , swollen ankle and legs , fatigue reduce exercise tolerance

DM THYROID MI , AF HTN
risk: FAILURE F= atty heart valve, arrhythmia, infarction, uncontrolled htn ,recreational drugs, evaders

Question 8

diagnosis biomarker

Answer 8

NT pro BNP, ecg ,cxr - large heart? pulmonary crackles?

Question 9

Left sided HF symptoms

Answer 9

pulmonary
DROWNING
D=yspnoea R= rales, orthonea (drown), nocturnal paroxysmal dyspnoea, N=agging cough I=nc HR W= weak heart g=ain weight

Question 10

rIGHT sided hf

Answer 10

peripheral symptoms
SWELLING
swelling arm and leg, w= e=pitting edema
Lethargic Large jugular irregular hrNocturnia , girth size in

Question 11

classification of HF

Answer 11

NYHA fuunctipnal classification defines progression Hf according to severity symptoms linked to physical activity

Question 12

stable/ chronic HF

Answer 12

symptoms unchanged 1+ months

Question 13

Tx ment algorithm LVHF <EF 40%

Answer 13

1)congestion? Does patient need diuretic (breathlessness and edema)
loop preferred (bumetanide, furosemide, torosemide) or
tzd (only if mild edema and egfr >30)

2) improve survival?1st line : acei/arbs +beta blocker
beta blocker licensed (candersartan valsartan) beta blocker (bisoprolol, carvedilol all stages) if mild mod stable hf age 70+ then nebivolol
(MAKE SURE TITRATE BOTH TO MAX TOLERATED DOSE)

3)patient not imPROVE add aldosterone antagonist (spiranoactone or eplerenone) to acei/arb +beta blocker

NEXT STAGES BELOW UNDER SPECIALIST
4) If patient cant tolerate acei/arb in 1st line give hydralazine and nitrate - esp in carribean and African

5) if EF <35% give sacubitirl / valsartan (entresto)

6) intensification if with standard treatment add on Ivrabradine if in sinus rhythm HR >70 BPM and ef <35- add ivrabradine
or add digoxin (in worsening or severe hF - does not reduced mortality
other options with specialist- implantable defibrillator implant or resynchronisation therapy

Question 14

monitoring in HF

Answer 14

acei/arb and AA : K+ and Na+ renal function and bp
1-2 weeks before start and each titration once target max reach monitor every 3 months and then every 6 months (and in acute illness)

BB- hr, bp , and symptom control at intitiation and titration
ckd- lower dose and slower titration of ace, aa, and digoxin

Question 15

med to avoid HF

Answer 15

nsaid - nephrotoxic, corticosteroid (low dose- short period) , antacid high na+, soluble analgesic, rate limit ccb avoid and short acting ccb (i.e nifedipine nicardipine diltiazem or verapamil), ANTIARRYTHMIC i.e fleicainde and dronedarone, pioglitazone

Question 16

CHD with preserved HF

Answer 16

tx low dose medium diurectic

Question 17

digoxin in HF

Answer 17

• doesn’t require plasma monitoring , reduces exacerbation of symptoms and hospitalisation not mortality

Question 18

vaccines in HF and lifestyle

Answer 18

influenza and pneumococcal, weigh daily see if increase in weight= worsening symptoms , decrease cffirene and salt intake. signs of deterioration = inc breathless decreased exercise tolerance , weight gain 2+kg in 2 days worsen oedema, or new nocturnal dyspnoea

Question 19

Use of diabetic medication in HF

Answer 19

SGLT2
can be used as add on therapy to acei/arb +beta blocker+ AA+ sglt2 i.e. 10mg dapagliflozin

Question 20

RI and HF

Answer 20

lower dose SGLT2, ACEI ARB, AA, ENTRESTO digoxin start low go slow in egfr 30-45