Heart Failure Flashcards
What is heart failure?
Impaired heart function, usually of the left ventricle - blood can’t get out to the body
What is the pathophysiology of heart failure?
Impaired left ventricular function resulting in blood backing up into the left ventricle and the rest of the heart
The left atrium, pulmonary vein and lungs are increased in volume and pressure
This results in pulmonary oedema
What is a normal ejection fraction?
Above 50%
What is ejection fraction?
The proportion of blood in the left ventricle that is pumped out of the heart with each contraction
What are the causes of heart failure?
Ischaemic heart disease
Valvular heart disease - aortic stenosis
Hypertension
Arrhythmias - AF
Cardiomyopathy
What is the presentation of heart failure?
Breathlessness
Cough with frothy pink/white sputum
Orthopnoea
Paroxysmal nocturnal dyspnoea
Peripheral oedema
Fatigue
What signs of heart failure would be seen on examination?
Tachypnoea
Tachycardia
Hypertension
Murmurs (if caused by valvulvar heart disease)
3rd heart sound
Bilateral basal crackles
Raised JVP
Peripheral oedema
What investigations are used to diagnose heart failure?
ECG
Echocardiogram
BNP
Bloods - LFT, TFT, U&E, FBC, lipids, HbA1c, inflammatory markers
Chest XR
What are the differentials of heart failure?
COPD
Pulmonary fibrosis
Pneumonia
Ageing/physical inactivity
What are the classes of heart failure?
Class 1 - no limitation of activity
Class 2 - comfortable at rest but symptomatic with normal activities
Class 3 - comfortable at rest but symptomatic with any activity
Class 4 - symptomatic at rest
What is the first line medical management of heart failure?
ACE inhibitor
Beta blocker
Aldosterone antagonist (if symptoms are not controlled by A+B)
Loop diuretics
What is the first line management of acute heart failure?
IV furosemide
What are the additional treatments in acute heart failure?
Oxygen
Vasodilators - nitrates
CPAP
