Heart Failure Flashcards
HF: complex syndrome resulting from a structural or functional disorder of the heart that impairs its ability to?
pump blood efficiently
HF symtpoms?
breathlessness, fatigue and fluid retention
avg life expectancy following hf diagnosis
3 years
what is the most common underlying cause of HF
coronary heart disease
what non-cardiac co-morbidities complicate care for patients with HF?
respiratory,
renal dysfunction,
anaemia,
arthritis,
depression
why do non-cardiac co-morbidities complicate care for patients with HF?
contribute to HF progression, polypharmacy, affect response to treatment
what are the 2 features that HF is usually characterised by?
reduced blood flow and fluid congestion
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
true
why does hf cause fluid congestion
ability to pump blood less efficient
body compensates
increases blood volume via fluid retention
what are 4 common causes of HF?
Coronary artery disease
High blood pressure
Cardiomyopathy
Faulty heart valves
on a physical examination what could be used as evidence for cardiac enlargement
lateral and downward displacement of the apex beat (with additional 3rd and 4th heart sounds)
what causes 3rd and 4th heart sounds that are typical in HF
valvular dysfunction
what does a raised jugular venous pressure, JVP indicate
venous congestion
what blood tests are used to investigate HF?
creatinine, urea, thyroid, NT pro-BNP, fasting blood glucose
why would you need creatinine and urea
assess renal function
why would you need fbc
check for anaemia
why would you measure thyroid function
possibility of thyrotoxicosis
why would you want to measure nt pro bnp levels
released when walls of heart stretched or pressure overload caused by fluid
why does bnp increase in HF
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
what would a normal ecg along with a low bnp level exclude
left ventricular dysfunction
if an ecg showed abnormalities what further cardiac investigation would be considered
echo
what would be the rationale behind doing a Chest xray
look for enlarged heart or consolidation in lungs
what 3 tests can be done to look at heart
ECG, CXR, ECHO
name of scan that is an ultrasound of the heart
echo
echo is used to confirm the diagnosis of hf and investigate any underlying cause, give one that it would pick up
valve disease
what can be calculated to assess the severity of hf
ejection fraction
describe nyha class 1
no limitation of physical activity and normal activity does not cause symptoms
describe nyha class 2
slight limit to physical activity, comfortable at rest but activity causes symptoms
describe nyha class 3
marked limitation to activity, comfortable at rest but less than ordinary activity causes symptoms
describe nyha class 4
severe limitations and discomfort with any activity and rest
surgical interventions are usually required if a patients ejection fraction drops below what %
35
4 different drug classes that are first line for treating hf
diuretics, acei, bb, mra
what is the rationale behind using diuretics?
relieves pulmonary and peripheral oedema by increasing na and cl excretion by blocking na reabs in renal tubule
why are loop diuretics such as furosemide preferred
increasing effect with increasing dose therefore allow dose titration
the intensity of action of loop diuretics like furosemide is challenged by side effects such as
hypovolemia and hypotension
drug class that is first class for all grades of HF due to LVF including those who are asymptomatic
acei
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
reduce preload afterload to increase cardiac output
name a drug class that can be used instead of acei in patients who cannot tolerate it due to persistent dry cough
ARBs
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
negative inotropic effects
what is meant by negative inotropic effect
weaken strength of muscle contraction
how can the mineralocorticoid aldosterone worsen symptoms of HF
cause water and na retention, sympathetic activation and parasympathetic inhibition
MRAs/ aldosterone antagonists work well when combine with an acei by facilitating a more complete blockade of
RAS
why does care need to be taken when using an mra and acei concomitantly
both increase K
name 3 drugs that are used for the specialist treatment of hf
ivabridine, sacubitril valsartan, dapagliflozin
how does ivabridine work to treat hf
reduces pacemaker activity of sa node to reduce heart rate
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
false
why can ivabridine only be initiated if being used with bb once pulse is over 75 bpm
potential for bradycardia
sacubitril is known as an x inhibitor
neprilysin
why is it important that neprilysin is inhibited in hf
breaks down endogenous vasoactive peptides therefore inhibiting increase plasma peptide levels which turns off ras activation
sacubitril is only available with valsartan and therefore patients must stop what class of drugs in exchange for the combination
acei
sacubitril valsartan is not to be started until x hrs after stopping acei due to risk of y
36 angioedema
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
dapagliflozin
Dapagliflozin. More commonly used in the treatment of ?
type II diabetes (a sodium-glucose transport protein 2, or SGLT2)
Why is JVP helpful in the assessment of a patient with HF?
provide insight into the patient’s fluid status and central venous pressure
if a patient is hypervolemic what effect would this have on jvp and why
Hypervolemia: Excess fluid in blood vessels.
Increase JVP as more BV increases VP
What might you see on a chest x-ray in a person with heart failure compared to a healthy patient
The heart looks larger and if there is a build up of fluid then the picture is more opaque showing oedema
role of loop diuretics in heart failure?
first line for the relief of symptoms
why can loop diuretics be advantageous when used with acei
ld causes hypokalemia and acei causes hyperkalemia so balanced out
what is ejection fraction
amount of blood pumped with each contraction from ventricles
true or false, ef number helps determine how effective the heart is functioning
true
what is a normal ef %
55-65
how is ef calculated
amount of blood pumped out by v/ total amount of blood in ventricle
ef is calculated during what other cardiac investigative procedure
echo
