Heart Failure Flashcards
What are typical symptoms of heart failure?
Breathlessness on exertion, at rest, or lying flat.
Fluid retention.
Fatigue.
Elevated jugular venous pressure.
Basal crepitations.
Peripheral oedema.
How is the severity of heart failure classified?
Using the New York Heart Association (NYHA) functional classification.
What should be examined in a person suspected of heart failure?
Tachycardia, pulse rhythm.
Lateral apex beat, murmurs, and heart sounds (gallop rhythm).
Hypertension.
Raised jugular venous pressure.
Enlarged liver.
Respiratory signs (tachypnoea, basal crepitations, pleural effusions).
Dependent oedema (legs, sacrum), ascites.
Obesity.
What is the most common underlying pathology of heart failure?
Coronary artery disease.
What are complications of heart failure?
Arrhythmias, depression, cachexia, CKD, sexual dysfunction, and sudden cardiac death.
How is heart failure classified based on ejection fraction?
HFrEF (Heart Failure with Reduced Ejection Fraction): LVEF ≤ 40%.
HFmrEF (Heart Failure with Mildly Reduced Ejection Fraction): LVEF 41–49%.
HF-PEF (Heart Failure with Preserved Ejection Fraction): LVEF ≥ 50%.
What is the role of serum natriuretic peptide (BNP) levels in diagnosing heart failure?
NT-pro-BNP levels above 2000 ng/L (236 pmol/L): urgent referral for assessment and echocardiography within 2 weeks.
NT-pro-BNP levels between 400 and 2000 ng/L (47–236 pmol/L): referral within 6 weeks.
Normal levels: unlikely diagnosis of heart failure.
What tests should be conducted if serum natriuretic peptide levels are elevated?
12-lead ECG.
Chest X-ray.
Blood tests (urea, electrolytes, eGFR, HbA1c, iron studies, thyroid tests).
Urine dipstick for blood and protein.
Lung function tests (peak flow, spirometry).
What are the risk factors for heart failure?
Coronary artery disease, myocardial infarction, hypertension, atrial fibrillation, diabetes.
Alcohol and drug use.
Family history of heart failure or sudden death under age 40.
What should be included in the management of people with confirmed heart failure?
Antiplatelet drug and statin.
Manage comorbidities and precipitating factors.
Screen for depression or anxiety.
Offer supervised exercise rehabilitation.
Provide self-care advice and nutritional assessments.
Advise on driving and travel considerations.
What is the management for heart failure with reduced ejection fraction (HFrEF)?
Offering a diuretic if there are symptoms of fluid overload.
Offering an angiotensin-converting enzyme (ACE) inhibitor plus a beta-blocker to all people.
Offering a mineralocorticoid receptor antagonist (MRA) in addition to an ACE inhibitor and beta-blocker if the person remains symptomatic.
Seeking specialist advice if the person remains symptomatic despite first-line treatment.
What is the management for heart failure with mildly reduced ejection fraction (HFmrEF)?
Offering a diuretic if there are symptoms of fluid overload.
Considering offering an ACE inhibitor, beta-blocker, and MRA.
What is the management for heart failure with preserved ejection fraction (HF-PEF)?
Offering a low to medium dose diuretic if necessary.
Arranging specialist referral if there is no response to treatment.
What specialist treatments may be initiated for heart failure?
Drug treatments: Loop and thiazide diuretics, spironolactone/eplerenone, sacubitril valsartan, hydralazine+nitrate, digoxin, ivabradine, SGLT2 inhibitors, anticoagulation, intravenous iron.
Surgical interventions: Cardiac resynchronization therapy, implantable cardioverter defibrillator (ICD), coronary revascularization, cardiac transplantation.
