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Refreshers > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

HF: complex syndrome resulting from a structural or functional disorder of the heart that impairs its ability to?

A

pump blood efficiently

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2
Q

HF symtpoms?

A

breathlessness, fatigue and fluid retention

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3
Q

avg life expectancy following hf diagnosis

A

3 years

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4
Q

what is the most common underlying cause of HF

A

coronary heart disease

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5
Q

what non-cardiac co-morbidities complicate care for patients with HF?

A

respiratory,
renal dysfunction,
anaemia,
arthritis,
depression

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6
Q

why do non-cardiac co-morbidities complicate care for patients with HF?

A

contribute to HF progression, polypharmacy, affect response to treatment

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7
Q

what are the 2 features that HF is usually characterised by?

A

reduced blood flow and fluid congestion

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8
Q

true or false, in simple terms hf is the inability of the heart to pump enough blood fast enough to meet the demands of the body and is a progressive disease than can occur suddenly or more commonly progress over a number of years

A

true

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9
Q

why does hf cause fluid congestion

A

ability to pump blood less efficient
body compensates
increases blood volume via fluid retention

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10
Q

what are 4 common causes of HF?

A

Coronary artery disease
High blood pressure
Cardiomyopathy
Faulty heart valves

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11
Q

on a physical examination what could be used as evidence for cardiac enlargement

A

lateral and downward displacement of the apex beat (with additional 3rd and 4th heart sounds)

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12
Q

what causes 3rd and 4th heart sounds that are typical in HF

A

valvular dysfunction

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13
Q

what does a raised jugular venous pressure, JVP indicate

A

venous congestion

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14
Q

what blood tests are used to investigate HF?

A

creatinine, urea, thyroid, NT pro-BNP, fasting blood glucose

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15
Q

why would you need creatinine and urea

A

assess renal function

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16
Q

why would you need fbc

A

check for anaemia

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17
Q

why would you measure thyroid function

A

possibility of thyrotoxicosis

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18
Q

why would you want to measure nt pro bnp levels

A

released when walls of heart stretched or pressure overload caused by fluid

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19
Q

why does bnp increase in HF

A

usually acts on kidneys to remove fluid and salt
in hf heart cannot pump strongly enough
walls stretch and fluid accumulates
more bnp released

higher bnp= poorer prognosis

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20
Q

what would a normal ecg along with a low bnp level exclude

A

left ventricular dysfunction

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21
Q

if an ecg showed abnormalities what further cardiac investigation would be considered

A

echo

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22
Q

what would be the rationale behind doing a Chest xray

A

look for enlarged heart or consolidation in lungs

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23
Q

what 3 tests can be done to look at heart

A

ECG, CXR, ECHO

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24
Q

name of scan that is an ultrasound of the heart

A

echo

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25
Q

echo is used to confirm the diagnosis of hf and investigate any underlying cause, give one that it would pick up

A

valve disease

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26
Q

what can be calculated to assess the severity of hf

A

ejection fraction

27
Q

describe nyha class 1

A

no limitation of physical activity and normal activity does not cause symptoms

28
Q

describe nyha class 2

A

slight limit to physical activity, comfortable at rest but activity causes symptoms

29
Q

describe nyha class 3

A

marked limitation to activity, comfortable at rest but less than ordinary activity causes symptoms

30
Q

describe nyha class 4

A

severe limitations and discomfort with any activity and rest

31
Q

surgical interventions are usually required if a patients ejection fraction drops below what %

A

35

32
Q

4 different drug classes that are first line for treating hf

A

diuretics, acei, bb, mra

33
Q

what is the rationale behind using diuretics?

A

relieves pulmonary and peripheral oedema by increasing na and cl excretion by blocking na reabs in renal tubule

34
Q

why are loop diuretics such as furosemide preferred

A

increasing effect with increasing dose therefore allow dose titration

35
Q

the intensity of action of loop diuretics like furosemide is challenged by side effects such as

A

hypovolemia and hypotension

36
Q

drug class that is first class for all grades of HF due to LVF including those who are asymptomatic

A

acei

37
Q

acei are generally well tolerated and have been shown to increase survival, decrease hospitalisations and improve symptoms in patients with mild to severe systolic dysfunction. How do they work to treat HF

A

reduce preload afterload to increase cardiac output

38
Q

name a drug class that can be used instead of acei in patients who cannot tolerate it due to persistent dry cough

A

ARBs

39
Q

bb reduce mortality in patients with mild to moderate HF however they should only be initiated when the patients condition is stable, why is this

A

negative inotropic effects

40
Q

what is meant by negative inotropic effect

A

weaken strength of muscle contraction

41
Q

how can the mineralocorticoid aldosterone worsen symptoms of HF

A

cause water and na retention, sympathetic activation and parasympathetic inhibition

42
Q

MRAs/ aldosterone antagonists work well when combine with an acei by facilitating a more complete blockade of

A

RAS

43
Q

why does care need to be taken when using an mra and acei concomitantly

A

both increase K

44
Q

name 3 drugs that are used for the specialist treatment of hf

A

ivabridine, sacubitril valsartan, dapagliflozin

45
Q

how does ivabridine work to treat hf

A

reduces pacemaker activity of sa node to reduce heart rate

46
Q

true or false, trials have not shown that ivabridine reduces hf deaths and hospitalisations in patients with more severe disease when added to conventional treatment

A

false

47
Q

why can ivabridine only be initiated if being used with bb once pulse is over 75 bpm

A

potential for bradycardia

48
Q

sacubitril is known as an x inhibitor

A

neprilysin

49
Q

why is it important that neprilysin is inhibited in hf

A

breaks down endogenous vasoactive peptides therefore inhibiting increase plasma peptide levels which turns off ras activation

50
Q

sacubitril is only available with valsartan and therefore patients must stop what class of drugs in exchange for the combination

A

acei

51
Q

sacubitril valsartan is not to be started until x hrs after stopping acei due to risk of y

A

36 angioedema

52
Q

can be used as an add on treatment and is shown to reduce cv deaths and HF events when used in conjuction with standard treatments

A

dapagliflozin

53
Q

Dapagliflozin. More commonly used in the treatment of ?

A

type II diabetes (a sodium-glucose transport protein 2, or SGLT2)

54
Q

Why is JVP helpful in the assessment of a patient with HF?

A

provide insight into the patient’s fluid status and central venous pressure

55
Q

if a patient is hypervolemic what effect would this have on jvp and why

A

Hypervolemia: Excess fluid in blood vessels.
Increase JVP as more BV increases VP

56
Q

What might you see on a chest x-ray in a person with heart failure compared to a healthy patient

A

The heart looks larger and if there is a build up of fluid then the picture is more opaque showing oedema

57
Q

role of loop diuretics in heart failure?

A

first line for the relief of symptoms

58
Q

why can loop diuretics be advantageous when used with acei

A

ld causes hypokalemia and acei causes hyperkalemia so balanced out

59
Q

what is ejection fraction

A

amount of blood pumped with each contraction from ventricles

60
Q

true or false, ef number helps determine how effective the heart is functioning

A

true

61
Q

what is a normal ef %

A

55-65

62
Q

how is ef calculated

A

amount of blood pumped out by v/ total amount of blood in ventricle

63
Q

ef is calculated during what other cardiac investigative procedure

A

echo

64
Q
A

Refreshers (10 decks)

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