Heart Failure Flashcards
HF
Pathophysiology
Inadequate tissue perfusion inspite of adequate filling pressure
HF
Presentation
SOB
HF
DDs of SOB
- Heart disease- HF
- Lung disease- Asthma, COPD, Lung fibrosis
- Renal failure- Pleural effusion/ pericardial effusion/ cardiomyopathy/ anemia
- Metabolic acidosis
- Anemia
HF
Classifications of HF
- Acute/ Chronic
- Systolic/ Diastolic
- Left/ right
HF
Systolic HF
ejection fraction is less (<60%)
HF
Diastolic HF
Heart is stiff and unable to stretch
HF
In which can the ejection fraction be normal
Diastolic HF
HF
Pulmonary edema Sx
- SOB
- B/L coarse crepts
- Patient tries to sit up
HF
Immediate Mx of acute heart failure
- 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
HF
IV frusemide function in acute LV failure Mx
Dilatation of veins occurs first,
diuretic effect comes later
HF
How long does it take for the diuretic effect of frusemide to come into action
around 30 minutes
HF
Function of GTN in acute HF Mx
Venodilation
HF
what needs to be done if the high stat frusemide dose cause the BP to crash
the pt may not respond to it so start an infusion (5mg/hr)
HF
In which situation should GTN be given in acute LVF
if the BP is normal or high
HF
Next step if Frusemide and GTN fails
CPPV
HF
In which situation should GTN be avoided
if the BP is low
HF
Added measures in acute LVF Mx
- dialysis
- venesection ( not done anymore)
HF
LV failure pathophysiology
- 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
HF
Why CPAP in acute LVF Mx
sending air in a positive pressure will push the fluid out of the airways. Reducing the pulm edema
HF
High output HF Examples
- Anemia
- Thyrotoxicosis
- Wet beri beri
- AV fistula
- Paget’s disease
HF
High output HF?
cardiac output is high but its still not enough to meet the demands
HF
Chronic HF
RHF secondary to LHF
HF
Chronic HF is also known as
congestive HF
HF
LHF clinical features
- exertional dyspnea
- orthopnea
- Paroxysmal nocturnal dyspnea
- B/L fine crepts
HF
why orthopnea in LHF
Abdominal organs will push the diaphragm + already SOB
HF
Paroxysmal nocturnal dyspnea
getting up w cough during sleep
HF
RHF clinical features
- elevated JVP
- Tender hepatomegaly
- B/L ankle edema
- Ascites
HF
RHF pathophysiology
- 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
HF
Underlying causes of Congestive HF
- IHD
- Valvular heart disease
- Long- term HTN
- Cardiomyopathy
HF
Ix for CHF
- ECG
- 2D echo
- BNP
- CXR
- FBC, LFT, BU, Sr.Cr
HF
ECG findings
- evidence of ischemic changes - MI
- arrhythmia
- valvular heart disease
HF
2D echo findings
- size of the ventricles/ contractility
- diastolic function
- valve structure
HF
Echo findings of diastolic failure
classical Sx of HF with preserved systolic function
HF
ECG change in HF
poor R wave progression V1- V6
HF
Echo findings with systolic failure
segmental wall motion abnormalities
HF
THE IX for HF
BNP- brain natriuretic peptide
HF
function of ANP, BNP
hormones that can cause Sodium and water removal
HF
In Dx HF, Whats the most newer test
NT- Pro BNP
HF
How can BNP Dx acute HF on top of chronic HF
BNP can Dx acute HF on top of chronic HF values will be very high. Report will come within hours.
HF
CXR findings
- Upper lobe diversion
- Kerley B lines
- Batwing wing
- Snow storm appearance
HF
Upper lobe diversion
blood is diverted to the upper lobes
HF
Kerley B lines
Fluid at the interstitium
HF
Batwing sign
Fluid at the hilum
HF
Snowstorm appearance
Fluid throughout the lung
HF
HF pathophysiology
- Increased sympathetic activity- Increased HR and Contractility
- Activate RAAS- increased aldosterone, sodium and water retention
- Cardiac remodelling- hypertrophy, dilatation
This is a viscious cycle and its bad long term
HF
Why do a FBC
Anemia can cause HF and worsen HF
HF
Why do a LFT
HF can cause secondary liver failure. Cardiac cirrhosis
HF
Why do a BU
HF can cause secondary renal failure. cardio- renal Xd
HF
Mx of chronic HF
- weight reduction
- dietary Mx
- Lifestyle Mx
- Vaccination
- Drug Mx
- Treat underlying cause
- Surgical Mx
- Device Mx
HF
Dietary Mx
Salt restriction
HF
Lifestyle Mx in HF
stop smoking, alcohol
HF
Vaccinations given
- Haemophilus
- Pneumococcal
- Influenza
HF
Drug Mx
- Frusemide
- ACEI
- beta Blockers
- Spironolactone
- Digoxin
- Warfarin
HF
Frusemide
Only Sx benefit, no mortality benefit
HF
Best drug/ first line drug
ACEI, has a mortality benefit
HF
The beta blockers used in HF
- Carvedilol
- Metoprolol succinate
- Bisoprolol
HF
When to add spironolactone
When there’s no response from ACEI and beta blockers
HF
HF Drugs with a high mortality risk
Digoxin
HF
Drugs that can increase mortality benefit
- ACEI
- Beta blockers
- Spironolactone
- Ivabradine
- Sacubutril valsartan
HF
When is digoxin given
used in HF with AF or in HF not responding to other drugs
HF
When is warfarin given
- When ejection fraction is very low
- LV aneurysm
- A-fib
HF
ARNIs
- sacubutril valsartan
- Ivabradine
HF
Surgical Mx
- Revascularization
- valve replacement
- aneurysectomy
HF
Device Mx in HF
- Implanntable cardiac defibrillators
- cardiac resync therapy
- Combined ICD+ CRT
HF
besides meds what else has a mortality benefit in HF Mx
- Surgical Mx
- Device Mx
HF
If the pt cannot tolerate ACEI, what to give
ARBs. But normally ACEI is the best
HF
V1- V4
Anterior surface
HF
V3, V4
septum
HF
aVL, V5
lateral
HF
III, II, aVL
inferior surface
