Heart Failure

Question 1

What is HeartFailure?

Answer 1

• It is the inability of the heart to pump sufficient around the body, meeting its needs.
  
  • Heart failure is a progressive clinical syndrome, caused by structural or functional abnormalities of the heart - resulting in reduced cardiac output.

Question 2

The TWO types:

Answer 2

1) Acute heart failure (AHF) - symptoms come on suddenly
2) Chronic heart Failure (CHF) - symptoms have been on going

Question 3

What are the symptoms of heart Failure?

Answer 3

• Shortness of breath (pulmonary oedema)
  
  • Persistent coughing or wheezing
  • Ankle swelling
  • Reduced exercise tolerance
  • Fatigue
  • Sometimes pulmonary crackles
  • Chest pains (if they have angina)
  • Palpitations(if they have arrhythmia)

Question 4

RISKS

Answer 4

The risk of heart failure is greater in Men, diabetic patients and increases with age.

Question 5

What are the causes of heart Failure:
6 ————LEVOOOO AND FERO

Answer 5

• CHD (Coronary heart disease) - this is the most common cause, especially after a heart attach(myocardial infarction)
  
  • Cardiomyopathy - disease of the heart muscle
  • Disease of the heart valve
  • Arrhythmia
  • Meds that damage the heart - excess alcohol, cocaine, chemo therapies
  • Non heart conditions- Hypo and hyperthyroidism and severe anaemia

Question 6

How is heart Failure diagnosed?- BNP OR NT-ProBNP

Answer 6

• Physical examination: Faster than normal pulse , enlarged heart, signs of fluid retention(eg swollen ankles ,enlarged liver, crackles in lungs
  
  • Blood tests: Measure B-type natriuretic peptide BNP or NT-proBNP (increase when a patient has heart failure)
  • Ecgs, X-rays, blood and urine tests

Question 7

Aims of the treatment: 4

Answer 7

• Reduce mortality
  
  • Relive the symptoms
  • Improve exercise tolerance
  • Reduce acute exacerbations.

Question 8

Non drug treatment

Answer 8

involves changing life style, encouraging smoking cessation, reducing alcohol consumption, weight loss and restricting the amount of salt used in their diets.

Question 9

Calcium channel blockers and heart failure: to avoiiiidddd which rate limiting and dihydropyrodine

Answer 9

• Avoid these(verapamil, diltiazem) and short acting dihydropyridines(eg.Nifedipine and nicardipine) - reduce cardiac contractility
  
  • Patients with angina and heart failure can safely use amlodipine

Question 10

LOOP DIURETICS - when are thiazides less effective

Answer 10

Whilst loop diuretics play an important role in managing and reducing fluid overload, there is no evidence of long term reduction in mortality:
1) Add on a loop diuretic like furosemide
2) Or a Thiazide diuretic in mild cases of heart failure.Thiazides are ineffective in renal failure where eGFR is less than 30ml/min

Question 11

Second line therapy: Aldosterone antagonist

Answer 11

• These can be referred to as mineralocorticoid receptor antagonists. Examples include spironolactone and Eplerenone
  
  • Both Ace inhibitors (which patients are likely to already be on) and aldosterone antagonists both cause hyperkalemia - therefore potassium should be monitored.

Question 12

There’s an increasing role for SGLT-2-inhibitors in the management of heart failure with a reduced ejection fraction

Answer 12

• These reduce glucose reabsorption and increase urinary glucose excretion. Examples include Canagliflozin, Dapagliflozin and Empagliflozin.
  
  • Evidence has shown that SGLT-2 inhibitors reduce hospitalisation, secondary to heart failure and cardiovascular death