Heart Failure Flashcards
What is the definition of heart failure?
Cardiac output inadequate for the bodies requirements.
What normally causes left sided heart failure?
Ischaemia heart disease e.g. MI.
Cardiomyopathy or valvular disease.
What normally causes right sided heart failure?
Left sided heart failure.
Cor pulmonale or congenital heart disease.
What are the symptoms of LVF?
Exertional dyspnoea. Orthopnoea. Paroxysmal nocturnal dyspnoea. Pulmonary oedema +/ pink frothy sputum. Weight loss, muscle wasting and cold peripheries.
What are the signs of LVF?
Tachycardia Fine crepitations Pleural effusions S3 gallop rhythm. Wheeze - cardiac asthma.
What is a gallop rhythm?
S3 plus tachycardia.
What signs are we looking for on X-ray for LVF?
Pulmonary oedema and ABCDE. Alveolar oedema. B Kerley B lines. Cardiomegaly Dilated upper lobe vessels. Effusion.
What are the symptoms of RVF?
Ankle and sacral oedema. Elevated JVP. Hepatomegaly. Ascites. Nausea, anorexia, facial engorgement and epistaxis.
What will a chest X-ray look like with RVF?
Normal.
What specific therapies do we use for HF with cor pulmonale?
Diuretics and oxygen only.
What specific therapies do we use for HF caused by valvular disease?
Surgery ideally.
What specific therapies do we use for HF caused by fast AF?
Digoxin or DC shock.
What specific therapies do we use for HF caused by previous MI or cardiomyopathies?
Standard medical treatment for CCF.
What are the 6 steps in standard medical treatment for CCF?
Diuretics.
ACEi or ARBs if can’t take the coughing.
Beta blockers with caution.
Spironalactone in severe cases only.
What non pharmacological standard medical treatment do we use for heart failure?
Implantable cardiac defibrillators.
Cardiac resynchronisation therapy.
Transplantation.
What kind of diuretics do we use for heart failure and what is a side effect of them?
Thiazides diuretics for mild only.
Loop diuretics are more common.
Both lose vitamin K.
What are the side effects of ace inhibitors used for heart failure?
Angioneurotic oedema - life threatening but rare.
First dose hypotension esp. if serum Na low.
Renal impariement.
Cough.
What are the risks and dosages of beta blockers we should use in heart failure?
Good in long term but can worsen CCF in the short term.
Start with a low dose and increase slowly.
Initial risks are worsening dyspnoea and hypotension.
When do we use ivabradine in heart failure?
Only use when beta blockers are in use and heart rate is still high as it slows this.
When do we use spironolactone in CCF and what are the side effects?
Use in severe CCF.
Hyperkaelaemia, renal dysfunction and gynaecomastia.
What is cardiac resynchronisation therapy?
When is it used?
3 pacemakers inserted to force LVH and RV to contract together.
Used for prolonged QRS only.
What is the therapeutic window of digoxin?
How is it excreted?
What did this mean for who we give it to?
Very narrow window.
Excreted slowly by kidneys. About 1/3rd excreted per day.
Elderly renal impairment means lower doses required.
What do we use digoxin for?
Excellent for AF. Mediocre therapy for heart failure.
What are the side effects of digoxin?
Nausea, vomiting, bradycardia, heart block, arrhythmias.
What does digoxin do to the atria and what can this cause?
Causes AV block.
It’s good at slowing fast AF, but can result in heart block and bradycardia.
What does digoxin do to the ventricles and what can this cause?
Irritates them and can cause ventricular arrhythmias.
What is the initial therapy for acute LVF?
Sit up, O2, IV furosemide and IV diamorph (not in COPD).
What are diuretics used for?
CCF or hypertension.
What are beta blockers used for?
Angina, hypertension, CCF.
What are ACE inhibitors used for?
CCF or hypertension.
What are calcium antagonists used for?
Hypertension or angina.
What are nitrates used for?
CCF or angina.
What investigation do we use initially for heart failure?
how do we interpret these results and what subsequent actions can we take dependent on the results?
ECG and BNP. If both normal HF is entirely unlikely and another diagnosis is required.
If either is abnormal then an echo is required.
Also do bloods and chest X-ray.
What blood tests do we do for heart failure?
FBC, U&Es BNP.
What are we looking for in an ECG for HF?
Signs of ischaemia e.g. Past MI or hypertrophy.
What are we looking for in an echo for HF?
Causes e.g. MI and valvular disease.
What criteria do we use for diagnosis of HF?
Framingham criteria.
What levels do we have in the New York classification of heart failure and when do they increase?
Levels 1-4.
Increases with dyspnoea and discomfort.
Where is BNP secreted from? What is it closely related to?
Ventricular myocardium.
Closely related to LV pressure.
Plasma BNP reflects myocyte stretch.
What happens to BNP during an MI and LV dysfunction?
It is released in large quantities.
What can we use BNP to differentiate between?
HF causes of dyspnoea and other forms.
What different rough levels of BNP do we get and what do they mean?
Highest in decompensated HF.
Intermediate in LVF.
Lower in acute HF exacerbation.
What is the relation of BNP to prognosis?
Higher the BNP the poorer the prognosis.
What is a diagnostic level of BNP and under what level is HF very unlikely?
Diagnostic >100ng/L.
Under 50ng/L there’s a 96% chance of it not being heart failure.
What is heart failure?
Syndrome, not one disease.
Can be low or high output, usually low.
Can be left/ right or mixed e.g. Congestive cardiac failure.
Can be acute or chronic.
