heart failure Flashcards
which part of heart is affected in HF
ventricles
what is HFpEF
> 50% ejection fraction
what is HFrEF
<50% ejection fraction
diagnosis of HFrEF
symptoms/signs eg peripheral oedema dyspnoea on exertion
corroborated by elevated B-type natriuretic peptide
refer for transthoracic echocardiogram
where is b-type natriuretic peptide synthesised
ventricles but also brain a little bit
what does b-type natriuretic peptide inhibir
aldosterone and adh
major cause of HFrEF
coronary artery disease
other causes of HF
hypertension
valvular disease
myocarditis
amyloidosis?
abnormal proteins deposited in brain liver heart. “stone heart”
amyloidosis symptoms
thickened myocardium
Pulm hypertension
stiff LV
HF chemotherapy risk drug
adriamycin
when ventricular remodelling
start of HF, RAAS and SNS
diagnostic for HFpEF
elevated LV filling pressures during diastole- diastolic dysfunction
what is orthopnoea
have to sit up to breathe
signs of HF (7)
elevated JVP (raised RA pressure)
3/4 heart sound
cardio megaly
hepatojugular reflex
peripheral oedema
pulmonary crackles
unintentional weight gain
side effect of amlodipine
ankle oedema
what look for in HF ECG
evidence of MI
AF
other arrhythmias
ecg findings in HF (4)
inferior Q waves
massive anterior T waves and ectopics
LBBB
acutre congestive HF treatment
diurese cautiously with loop diureti
why diurese cautiously?
if RV failure or aortic stenosis, can lower preload too much and drop systolic bp dangerously low
what do you have to monitor with loop diuretic
electrolytes
magnesium and potassium
problem with HF and hypokalemia
increases risk of arrythmia which already has elevated risk
HFrEF chronic pharm management
beta blocker (SNS) and loop/thiazide like diuretic
ARNI
or ARB
or ACEI
what is ARNI
ARB plus neprilysin inhibitor
what is neprilysin
degrades BNP
what meds useless in HFpEF
B blockers
ARNI
RAAS inhibitors
how to treat HFpEF
co-morbidities
fluid retention
SGLT2 inhibitors
other very good drugs for HFrEF
mineralocorticoid antagonist such as spironolactone
SGLT2 inhibitor
QUAD therapy for HFrEF
BB, MRA, SGLT2i, ARNI
what is SGLT2 inhibitor
SGLT2 inhibitors, which are also called gliflozins, are a class of drugs that lower your blood sugar levels by preventing your kidneys from reabsorbing sugar that is created by your body and the extra sugar leaves through in your urine.
sglt2 inhibitor example
**dapagliflozin
gliflozin is the key ending
