Heart Failure Flashcards
What is heart failure?
Clinical syndrome where the heart cannot pump enough blood to meet metabolic demand.
What are the classifications of heart failure by ejection fraction?
- Heart failure with preserved ejection fraction (HF-pEF)
- Heart failure with reduced ejection fraction (HF-rEF)
What is reduced left ventricular ejection fraction (LVEF)?
LVEF < 35-40%
What characterizes heart failure with preserved ejection fraction (HF-pEF)?
Often have diastolic dysfunction. Examples: hypertrophic obstructive cardiomyopathy, restrictive cardiomyopathy, cardiac tamponade, constrictive pericarditis.
What characterizes heart failure with reduced ejection fraction (HF-rEF)?
Often have systolic dysfunction. Examples: Ischaemic heart disease, myocarditis, arrhythmias, dilated cardiomyopathy.
What is acute heart failure?
Refers to an acute exacerbation of chronic heart failure with symptoms due to LV failure resulting in pulmonary oedema.
What are the causes of left-sided heart failure?
Increased LV afterload (arterial hypertension or aortic stenosis) or increased LV preload (aortic regurgitation).
What are the consequences of left-sided heart failure?
Pulmonary oedema leading to dyspnoea, paroxysmal nocturnal dyspnoea, and bibasal fine crackles.
What causes right-sided heart failure?
Increased RV afterload (pulmonary hypertension) and increased RV preload (tricuspid regurgitation).
What are the consequences of right-sided heart failure?
Peripheral oedema, raised JVP, hepatomegaly, weight gain/fluid retention, anorexia (‘cardiac cachexia’).
What is high-output heart failure?
‘Normal’ heart unable to meet metabolic need. Causes include anaemia, AVM, Paget’s disease, pregnancy, thyrotoxicosis, thiamine deficiency.
What are the common causes of chronic heart failure?
Ischaemic heart disease, valvular heart disease (aortic stenosis), hypertension, arrhythmias, cardiomyopathy.
What symptoms are associated with chronic heart failure?
Dyspnoea, cough (worse at night + pink/frothy sputum), orthopnoea, paroxysmal nocturnal dyspnoea, wheeze, weight loss.
What signs indicate chronic heart failure?
Bibasal crackles, raised JVP, ankle oedema, hepatomegaly, murmur, S3 sound.
What is the first blood test to assess heart failure?
N-terminal pro-B-type natriuretic peptide (NT-proBNP) - raised with ‘stretch’ of the heart.
What is the New York Heart Association (NYHA) classification for heart failure?
Class I: No symptoms + No limitations
Class II: Mild symptoms + Slight limitation
Class III: Moderate symptoms + Marked limitation
Class IV: Severe symptoms + Symptoms present at rest.
What system is used to classify heart failure?
New York Heart Association (NYHA) classification for heart failure?
What is the first line management for HF-pEF?
ACE inhibitors OR ARB
AND
Beta-blockers (e.g., Bisoprolol).
What is the second line management for HF-pEF?
Add MRA (Spironalactone) + SGLT-2i
What is the first line management for HF-rEF?
MRA + SGLT-2i
(then 2nd line - seek specilist)
What is the role of aldosterone antagonists in heart failure management + what has to be monitored?
- Prevent H2O reabsorption, reducing the amount of work the heart has to do.
- Monitor K+ as aldosterone antagonists and ACE-inhibitors cause hyperkalemia –> U&Es *
What is acute heart failure?
Life-threatening emergency with sudden onset in worsening HF symptoms.
What are the types of acute heart failure?
- De-novo AHF
- Decompensated AHF.
What causes de-novo heart failure?
Increased cardiac filling pressures and myocardial dysfunction.
What are the signs of decompensated heart failure?
Acute coronary syndrome, hypertensive crisis, acute arrhythmia, valvular disease.
What imaging is used to diagnose heart failure?
CXR and Echo. (measure EF)
What findings are associated with heart failure on CXR?
A: Alveolar oedema
B: Kerley B lines
C: Cardiomegaly
D: Dilated upper lobe vessels
E: Effusions.
What is the management for all patients with acute heart failure?
IV loop diuretics e.g., Furosemide.
What should be avoided in acute heart failure management?
Opiates, as they have shown to reduce mortality.
What is the role of CPAP in acute heart failure?
Used for patients with respiratory failure.
What is the management for patients with hypotension in acute heart failure?
Ionotropic agents - Dobutamine with HDU support, Vasopressor agents - NAd.
