Heart Failure Flashcards
What ejection fraction is considered normal?
50%
What are the causes of chronic heart failure?
Ischaemic heart disease
Valvular heart disease - aortic stenosis
Hypertension
Arrhythmias - AF
Cardiomyopathy
What are the key symptoms of heart failure?
Breathlessness
Peripheral oedema
Orthopnoea
Cough - pink/white frothy sputum
Fatigue
Paroxysmal nocturnal dyspnoea
What are the signs of heart failure on examination?
Tachycardia
Tachypnoea
Hypertension
Murmurs
3rd heart sound on auscultation
Raised JVP
Bilateral basal crackles
Peripheral oedema
What is paroxysmal nocturnal dyspnoea?
The experience of patients waking up in the night with a severe attack of breathlessness, cough and wheeze
What are the main investigations for diagnosis of heart failure?
NT-proBNP
ECG
Echocardiogram
What other investigations may be performed in the diagnosis of heart failure?
Bloods - anaemia, renal function, thyroid function, liver function, lipids, diabetes
CXR - to exclude lung pathology
What is the NYHA classification of heart failure?
Class 1 - no limitation on activity
Class 2 - comfortable at rest, symptomatic with normal activities
Class 3 - comfortable at rest, symptomatic with any activity
Class 4 - symptomatic at rest
How quick should heart failure patients be referred to cardiology?
If BNP between 400 and 2000 - referral and echo within 6 weeks
If BNP > 2000 - referral and echo within 2 weeks
What vaccines should heart failure patients be given?
Pneumococcal vaccine
Flu vaccine annually
Covid vaccine annually
What is the pharmacological management of heart failure?
ABAL
- ACE inhibitor
- Beta blocker
- Aldosterone antagonist (if symptoms are not controlled)
- Loop diuretics
When is an aldosterone antagonist used in heart failure?
When ejection fraction is less than 50%, and symptoms are not adequately controlled with an ACE inhibitor and a beta blocker
