Heart failure Flashcards by Hellie Cumming

How does the neurohormonal system incr cardiac output?

Sympathetic NS causes vasocontriction

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What is on the x and y axes of the Frank - Starling curve/

X - LVED

Y - Stroke volume

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Describe the steps of the RAAS

Angiotensinogen > angiotensin > angiotensin II > vasoconstriction + aldosterone + slat/water retention

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Symptoms of HF

Oedema (peripheral)
SOD
Incr nocturia

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Causes of HF

Arrhythmias
Valve disease
Cardiomyopathy
Hypertension
finish

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What features on a CXR indicate HF? (5)

…

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What is the prognosis for Class IV HF?

Terminal

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What are you trying ot balance when treating HF?

Pulmonary oedema vs cardiogenic shock

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What are the lifestyle changes patients should make in HF? What mpact ot they have on mortality?

Exercise
Smoking (as conrory disease)
Alcohol (if alcoholic HF)

No diff on mortality

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Which drugs reduce mortality inn HF?

Beta blocckers, ACEIs, sprinoalactone, ARBs (least), nitrates (least)

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Which 2 drugs used in HF have NO impact on mortality?

Diuretics

Digoxin

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Which diuretic is used most in HF?

Furosemide (loop diuretic)

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What should you do to iiuretic dose in a patient iwth kidney problems? Why?

Increase it. There is hypoperfusion.

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Where do loop diuretics act?

Na/Cl/K symporter

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Side effects of diurretics? (5)

Hypokalaemia
Hyponatraemia
Volume depletion
Renal impairment 
Gout

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2 classes of vasodilators? Difference?

Organic nitrates (venous)
Hydralazine (arterial)

Often used in combo

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ACEi reduciton in mortality? In which patiets is the effect bigger?

20-25%

Severe LV function

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How should you choose which drug (within a class)

Greatest trial experience ad safety data

Cost

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ACEi reduce hospital admissions

…

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At what point do you need to worry about rise in U+Es when using ACEis?

When 50% above baseline

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What should you switch ACEi to if cough is troublesomee?

ARBs

Which of ARBs and ACEis is better mortality wise?

Neither (use ACEis unless not tolerant)

What should you do first when someone’s HF deterioratees?

Look for cause of decompensation

What is the next treatment step after ACEis?

Beta blockers

What can beta blockers do in large doses to HF

Can REDUCE inotropic ability of heart

Which beta blockers are not efficacious? Why?

Atenolol. Large doses so poss precipitate HF?

Which drug is the next step after b-blockers in HF?

Sprinonolactone (ARB)

Side effects of spironalactone?

Rise in serum potassium | Gynacomastia

Why might yoou consider warfarin in HF?

Poor vent function --> clots

Surgical interventions?

Coronary revasculaisation Cardiaac resynch therapy (PM put in) Cardiac transplantation (congenital, acquired cardiomyopathies)

Heart failure: diagnosis?

No, it is a syndrome! Look for underling causes

Most common cause of HF in western world?

Ischaemic heart disease

Methods the body uses to compensate for inadequate cardiac function? (5)

``` Sympathetic NS Renin angiotensin system Natriuretic peptides Ventricular dilatation Ventricular remodelling ```

3 beneficial methods by which symp NS acts in HF and 1 unhelpful mech.

Helpful - incr HR - incr myocardial contractility - venous constriction, incr preload and so incr Unhelpful - arteriolar constriction and so incr afterload

How is renin angiotensin system activated?

Decr renal perfusion

What are the positive and negative impacts of incr salt and water retention?

Positive - incr venous pressure and so maintained stroke volume Neg - peripheral and pulmonary congestion

What is one of the unhelpful features of angiotensin II re. HF?

arteriolar constriction - incr afterload

Name 3 natriuretic peptides, where are they released from? What are their 3 main effects?

ANP (atrial natriuretic peptide) - released from atria BNP (brain natriuretic peptide) - form ventricles C-type peptide - from vascular endothelium Diuresis, natriuresis, hypotension

Describe the impact of ventricular dilatation on HF composition.

At first, stretching is good because Starling's curve means that incr in contractility. BUT once HF is established, benefit flattens so incr preload no longer has positive impact. Incr venous pressure eventually causes plum and perish oedema. ALSO - incr ventricular diameter, means more tension is required to pump same volume of blood

Ventricular remodelling - what happens, what is the effect?

Hypertrophy, loss of myocytes, incr in interstitial fibrosis | = pump failure

Most common cause of LV systolic dysfunction?

Ischaemic heart disease

Causes of RV systolic dysfunction? (4)

Secondary to LVSD Pulmonary hypertension (1ary or 2ary) Ischaemia of R heart Adult congenital heart disease

What is diastolic heart failure?

Syndrome with signs of heart failure but with near/normal LV ejection fraction and evidence of diastolic dysfunction on echo.

How would diastolic dysfunction appear on an echo?

Abnormal LV relaxation and filling, norm with LV hypertrophy

Symptoms of HF? 5

``` Exertional dyspnoea Orthopnea PND Fatigue Cough - pink and frothy ```

Signs of HF, describe how following can be affected? - Heart size? apex? - Heart sounds - Neck? - HR and BP - Auscultation - Percussion - Peripheries - Abdomen

``` Cardiomegaly with displaced apex beat S3 gallop Raised JVP Tachy + hypotensive Bi-basal lung crackles Pleural effusion (dull percussion) Ankle oedema Ascites + tender hepatomegaly ```

CXR features of LVF? (5)

``` Cardiomegaly Pleural effusion Kerley B lines (interstitial oedema) 'Bat wings' Dilated prom upper lobe vessels ```

What do 'bat wings' on a CXR signify?

Alveolar oedema

Describe 4 classes of HF (NYHA)

II - normal exercise causes no problems II - normal phys activity causes fatigue, dysp or palpitations III - mild phys act causes symptoms IV - symptoms at rest

In HFm why do you order the following tests? - FBC - LFTs - Glucose - Us and Es - thyroid function tests (who? why?) What other test is v imp in HF diagnosis?

- Check for anaemia (can exacerbate HF) - Liver might be affected - Check for diabetes - Baseline before starting ACEis and diuretics - Old patients and those with Afib. Hyper/hypothyroidism can cause heart failure. Thyroid function closely linked to risk of a-fib. BNP! Normal concs <100 exclude HF

What ejection fraction is usually seen as evidence for HF?

<0.45