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1st Year Medicine > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is the definition of heart failure?

A

Cardiac output inadequate for the bodies requirements.

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2
Q

What normally causes left sided heart failure?

A

Ischaemia heart disease e.g. MI.

Cardiomyopathy or valvular disease.

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3
Q

What normally causes right sided heart failure?

A

Left sided heart failure.

Cor pulmonale or congenital heart disease.

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4
Q

What are the symptoms of LVF?

A 
Exertional dyspnoea.
Orthopnoea.
Paroxysmal nocturnal dyspnoea.
Pulmonary oedema +/ pink frothy sputum.
Weight loss, muscle wasting and cold peripheries.
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5
Q

What are the signs of LVF?

A 
Tachycardia
Fine crepitations
Pleural effusions
S3 gallop rhythm.
Wheeze - cardiac asthma.
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6
Q

What is a gallop rhythm?

A

S3 plus tachycardia.

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7
Q

What signs are we looking for on X-ray for LVF?

A 
Pulmonary oedema and ABCDE.
Alveolar oedema.
B Kerley B lines.
Cardiomegaly 
Dilated upper lobe vessels.
Effusion.
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8
Q

What are the symptoms of RVF?

A 
Ankle and sacral oedema.
Elevated JVP.
Hepatomegaly.
Ascites.
Nausea, anorexia, facial engorgement and epistaxis.
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9
Q

What will a chest X-ray look like with RVF?

A

Normal.

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10
Q

What specific therapies do we use for HF with cor pulmonale?

A

Diuretics and oxygen only.

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11
Q

What specific therapies do we use for HF caused by valvular disease?

A

Surgery ideally.

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12
Q

What specific therapies do we use for HF caused by fast AF?

A

Digoxin or DC shock.

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13
Q

What specific therapies do we use for HF caused by previous MI or cardiomyopathies?

A

Standard medical treatment for CCF.

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14
Q

What are the 6 steps in standard medical treatment for CCF?

A

Diuretics.
ACEi or ARBs if can’t take the coughing.
Beta blockers with caution.
Spironalactone in severe cases only.

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15
Q

What non pharmacological standard medical treatment do we use for heart failure?

A

Implantable cardiac defibrillators.
Cardiac resynchronisation therapy.
Transplantation.

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16
Q

What kind of diuretics do we use for heart failure and what is a side effect of them?

A

Thiazides diuretics for mild only.
Loop diuretics are more common.
Both lose vitamin K.

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17
Q

What are the side effects of ace inhibitors used for heart failure?

A

Angioneurotic oedema - life threatening but rare.
First dose hypotension esp. if serum Na low.
Renal impariement.
Cough.

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18
Q

What are the risks and dosages of beta blockers we should use in heart failure?

A

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.

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19
Q

When do we use ivabradine in heart failure?

A

Only use when beta blockers are in use and heart rate is still high as it slows this.

20
Q

When do we use spironolactone in CCF and what are the side effects?

A

Use in severe CCF.

Hyperkaelaemia, renal dysfunction and gynaecomastia.

21
Q

What is cardiac resynchronisation therapy?

When is it used?

A

3 pacemakers inserted to force LVH and RV to contract together.
Used for prolonged QRS only.

22
Q

What is the therapeutic window of digoxin?
How is it excreted?
What did this mean for who we give it to?

A

Very narrow window.
Excreted slowly by kidneys. About 1/3rd excreted per day.
Elderly renal impairment means lower doses required.

23
Q

What do we use digoxin for?

A

Excellent for AF. Mediocre therapy for heart failure.

24
Q

What are the side effects of digoxin?

A

Nausea, vomiting, bradycardia, heart block, arrhythmias.

25
Q

What does digoxin do to the atria and what can this cause?

A

Causes AV block.

It’s good at slowing fast AF, but can result in heart block and bradycardia.

26
Q

What does digoxin do to the ventricles and what can this cause?

A

Irritates them and can cause ventricular arrhythmias.

27
Q

What is the initial therapy for acute LVF?

A

Sit up, O2, IV furosemide and IV diamorph (not in COPD).

28
Q

What are diuretics used for?

A

CCF or hypertension.

29
Q

What are beta blockers used for?

A

Angina, hypertension, CCF.

30
Q

What are ACE inhibitors used for?

A

CCF or hypertension.

31
Q

What are calcium antagonists used for?

A

Hypertension or angina.

32
Q

What are nitrates used for?

A

CCF or angina.

33
Q

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?

A

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.

34
Q

What blood tests do we do for heart failure?

A

FBC, U&Es BNP.

35
Q

What are we looking for in an ECG for HF?

A

Signs of ischaemia e.g. Past MI or hypertrophy.

36
Q

What are we looking for in an echo for HF?

A

Causes e.g. MI and valvular disease.

37
Q

What criteria do we use for diagnosis of HF?

A

Framingham criteria.

38
Q

What levels do we have in the New York classification of heart failure and when do they increase?

A

Levels 1-4.

Increases with dyspnoea and discomfort.

39
Q

Where is BNP secreted from? What is it closely related to?

A

Ventricular myocardium.
Closely related to LV pressure.
Plasma BNP reflects myocyte stretch.

40
Q

What happens to BNP during an MI and LV dysfunction?

A

It is released in large quantities.

41
Q

What can we use BNP to differentiate between?

A

HF causes of dyspnoea and other forms.

42
Q

What different rough levels of BNP do we get and what do they mean?

A

Highest in decompensated HF.
Intermediate in LVF.
Lower in acute HF exacerbation.

43
Q

What is the relation of BNP to prognosis?

A

Higher the BNP the poorer the prognosis.

44
Q

What is a diagnostic level of BNP and under what level is HF very unlikely?

A

Diagnostic >100ng/L.

Under 50ng/L there’s a 96% chance of it not being heart failure.

45
Q

What is heart failure?

A

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.

1st Year Medicine (64 decks)

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