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Cardiology > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

HF

Pathophysiology

A

Inadequate tissue perfusion inspite of adequate filling pressure

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2
Q

HF

Presentation

A

SOB

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3
Q

HF

DDs of SOB

A
  • Heart disease- HF
  • Lung disease- Asthma, COPD, Lung fibrosis
  • Renal failure- Pleural effusion/ pericardial effusion/ cardiomyopathy/ anemia
  • Metabolic acidosis
  • Anemia
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4
Q

HF

Classifications of HF

A
  • Acute/ Chronic
  • Systolic/ Diastolic
  • Left/ right
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5
Q

HF

Systolic HF

A

ejection fraction is less (<60%)

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6
Q

HF

Diastolic HF

A

Heart is stiff and unable to stretch

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7
Q

HF

In which can the ejection fraction be normal

A

Diastolic HF

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8
Q

HF

Pulmonary edema Sx

A
  • SOB
  • B/L coarse crepts
  • Patient tries to sit up
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9
Q

HF

Immediate Mx of acute heart failure

A
  • Admit the pt
  • ABC
  • Give O2, if SpO2 <94%
  • IV cannula and collect the blood for Ix
  • IV frusemide- 80- 120mg
  • GTN infusion
  • If no response CPPV
  • Added measures- Dialysis, venesection
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10
Q

HF

IV frusemide function in acute LV failure Mx

A

Dilatation of veins occurs first,
diuretic effect comes later

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11
Q

HF

How long does it take for the diuretic effect of frusemide to come into action

A

around 30 minutes

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12
Q

HF

Function of GTN in acute HF Mx

A

Venodilation

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13
Q

HF

what needs to be done if the high stat frusemide dose cause the BP to crash

A

the pt may not respond to it so start an infusion (5mg/hr)

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14
Q

HF

In which situation should GTN be given in acute LVF

A

if the BP is normal or high

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15
Q

HF

Next step if Frusemide and GTN fails

A

CPPV

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16
Q

HF

In which situation should GTN be avoided

A

if the BP is low

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17
Q

HF

Added measures in acute LVF Mx

A
  • dialysis
  • venesection ( not done anymore)
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18
Q

HF

LV failure pathophysiology

A
  • LV pumping reduced
  • Blood accumulates in the left ventricle
  • workload on the L/atrium to send blood to the ventricle is high
  • pressure in the L/atrium is high
  • pressure increase in the pulm vessels
  • fluid leaks out of the pulm vessels giving pulm edema
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19
Q

HF

Why CPAP in acute LVF Mx

A

sending air in a positive pressure will push the fluid out of the airways. Reducing the pulm edema

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20
Q

HF

High output HF Examples

A
  • Anemia
  • Thyrotoxicosis
  • Wet beri beri
  • AV fistula
  • Paget’s disease
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21
Q

HF

High output HF?

A

cardiac output is high but its still not enough to meet the demands

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22
Q

HF

Chronic HF

A

RHF secondary to LHF

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23
Q

HF

Chronic HF is also known as

A

congestive HF

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24
Q

HF

LHF clinical features

A
  • exertional dyspnea
  • orthopnea
  • Paroxysmal nocturnal dyspnea
  • B/L fine crepts
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25
Q

HF

why orthopnea in LHF

A

Abdominal organs will push the diaphragm + already SOB

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26
Q

HF

Paroxysmal nocturnal dyspnea

A

getting up w cough during sleep

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27
Q

HF

RHF clinical features

A
  • elevated JVP
  • Tender hepatomegaly
  • B/L ankle edema
  • Ascites
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28
Q

HF

RHF pathophysiology

A
  • R/ ventricle pumping is reduced
  • Blood accumulates in the RV
  • Workload on the R/ atrium is high
  • Blood backup in the R/atrium. Pressure increases
  • Blood backup in the SVC and IVC. Pressure increases
  • Fluid leaks out giving fluid overload Sx
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29
Q

HF

Underlying causes of Congestive HF

A
  • IHD
  • Valvular heart disease
  • Long- term HTN
  • Cardiomyopathy
30
Q

HF

Ix for CHF

A
  • ECG
  • 2D echo
  • BNP
  • CXR
  • FBC, LFT, BU, Sr.Cr
31
Q

HF

ECG findings

A
  • evidence of ischemic changes - MI
  • arrhythmia
  • valvular heart disease
32
Q

HF

2D echo findings

A
  • size of the ventricles/ contractility
  • diastolic function
  • valve structure
33
Q

HF

Echo findings of diastolic failure

A

classical Sx of HF with preserved systolic function

34
Q

HF

ECG change in HF

A

poor R wave progression V1- V6

35
Q

HF

Echo findings with systolic failure

A

segmental wall motion abnormalities

36
Q

HF

THE IX for HF

A

BNP- brain natriuretic peptide

37
Q

HF

function of ANP, BNP

A

hormones that can cause Sodium and water removal

38
Q

HF

In Dx HF, Whats the most newer test

A

NT- Pro BNP

39
Q

HF

How can BNP Dx acute HF on top of chronic HF

A

BNP can Dx acute HF on top of chronic HF values will be very high. Report will come within hours.

40
Q

HF

CXR findings

A
  • Upper lobe diversion
  • Kerley B lines
  • Batwing wing
  • Snow storm appearance
41
Q

HF

Upper lobe diversion

A

blood is diverted to the upper lobes

42
Q

HF

Kerley B lines

A

Fluid at the interstitium

43
Q

HF

Batwing sign

A

Fluid at the hilum

44
Q

HF

Snowstorm appearance

A

Fluid throughout the lung

45
Q

HF

HF pathophysiology

A
  1. Increased sympathetic activity- Increased HR and Contractility
  2. Activate RAAS- increased aldosterone, sodium and water retention
  3. Cardiac remodelling- hypertrophy, dilatation
    This is a viscious cycle and its bad long term
46
Q

HF

Why do a FBC

A

Anemia can cause HF and worsen HF

47
Q

HF

Why do a LFT

A

HF can cause secondary liver failure. Cardiac cirrhosis

48
Q

HF

Why do a BU

A

HF can cause secondary renal failure. cardio- renal Xd

49
Q

HF

Mx of chronic HF

A
  • weight reduction
  • dietary Mx
  • Lifestyle Mx
  • Vaccination
  • Drug Mx
  • Treat underlying cause
  • Surgical Mx
  • Device Mx
50
Q

HF

Dietary Mx

A

Salt restriction

51
Q

HF

Lifestyle Mx in HF

A

stop smoking, alcohol

52
Q

HF

Vaccinations given

A
  • Haemophilus
  • Pneumococcal
  • Influenza
53
Q
A
54
Q

HF

Drug Mx

A
  • Frusemide
  • ACEI
  • beta Blockers
  • Spironolactone
  • Digoxin
  • Warfarin
55
Q

HF

Frusemide

A

Only Sx benefit, no mortality benefit

56
Q

HF

Best drug/ first line drug

A

ACEI, has a mortality benefit

57
Q

HF

The beta blockers used in HF

A
  • Carvedilol
  • Metoprolol succinate
  • Bisoprolol
58
Q

HF

When to add spironolactone

A

When there’s no response from ACEI and beta blockers

58
Q

HF

HF Drugs with a high mortality risk

A

Digoxin

59
Q

HF

Drugs that can increase mortality benefit

A
  • ACEI
  • Beta blockers
  • Spironolactone
  • Ivabradine
  • Sacubutril valsartan
60
Q

HF

When is digoxin given

A

used in HF with AF or in HF not responding to other drugs

61
Q

HF

When is warfarin given

A
  • When ejection fraction is very low
  • LV aneurysm
  • A-fib
62
Q

HF

ARNIs

A
  • sacubutril valsartan
  • Ivabradine
63
Q

HF

Surgical Mx

A
  • Revascularization
  • valve replacement
  • aneurysectomy
64
Q

HF

Device Mx in HF

A
  • Implanntable cardiac defibrillators
  • cardiac resync therapy
  • Combined ICD+ CRT
65
Q

HF

besides meds what else has a mortality benefit in HF Mx

A
  • Surgical Mx
  • Device Mx
66
Q

HF

If the pt cannot tolerate ACEI, what to give

A

ARBs. But normally ACEI is the best

67
Q

HF

V1- V4

A

Anterior surface

68
Q

HF

V3, V4

A

septum

69
Q

HF

aVL, V5

A

lateral

70
Q

HF

III, II, aVL

A

inferior surface

Cardiology (7 decks)

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