Heart failure Flashcards
What are the causes of heart failure?
Ischaemic heart disease Non-Ischaemic dilated cardiomyopathy Hypertension Valvular disease CHD Arrhythmias Pericardial disease Alcohol/drugs Hyperdynamic circulation (Anaemia, Thyrotoxicosis, Padgets)
What murmur can occur in LHF?
Mitral regurgitation - Displaced apex beat
What murmur can occur in RHF?
Tricuspid regurgitation - Pansystolic, V waves, Pulsatile
What are some of the physiological changes in HF?
Ventricular dilatation Myocyte hypertrophy Neurohumeral - Increased ANP Salt/Water retention Sympathetic stimulation Peripheral vasoconstriction
How do you calculate CO?
CO = SV x HR
How is CO maintained in patients with heart failure?
Increase in venous pressure
Tachycardia
Decreased CO causes Adrenergic activation and RAAS activation
What is an objective measure of heart failure?
Ejection fraction seen on echo Normal = >55% Mild = 45-54% Moderate = 35-44% Severe =
What are the symptoms of LHF?
Fatigue
Orthopnoea/PND
Exertional dyspnoea
What are the signs of LHF?
Displaced apex beat due to cardiomegaly
Gallop rhythm heard on auscultation - 3rd heard sound, kentucky
Features of mitral regurgitation
Crackles at the lung bases due to pulmonary oedema
Pitting oedema dependent on the activation of RAAS
What valvular diseases cause LHF?
Mitral/Aortic
Mitral stenosis causes LA HTN and signs of LV failure, but does itself not cause the LV to fail
What are the causes of LHF?
Ischaemic heart disease
Non ischaemic dilated cardiomyopathy
HTN
Mitral/Aortic valve disease
What are the causes of RHF?
Chronic lung disease (Cor Pulmonale) PE Pulmonary HTN Tricuspid/Pulmonary valve disease Left to right shunts (ASD/VSD) Isolated RV cardiomyopathy
What are the symptoms of RHF?
Fatigue
Dyspnoea
Anorexia/Nausea
What are the signs of RHF?
Increased jugular venous pressure V waves of Tricuspid regurgitation (Seen in julgular vein, measn RV enlargement) Cardiomegaly Hepatic enlargement - tender and smooth Ascites Peripheral pitting oedema
What investigations would you perform in a patient with suspected heart failure?
Bloods - FBC, ANP/BNP, LFT, U&Es
CXR
Echocardiogram
What is the NYHA HR classification - Class I?
No limitation of physical activity
What is the NYHA HR classification - Class II?
Slight limitation of physical activity - Symptomatically mild heart failure
What is the NYHA HR classification - Class III?
Marked limitation of physical activity - Symptomatically moderate heart failure
What is the NYHA HR classification - Class IV?
Symptoms at rest - Symptomatically severe heart faulure
What is the general lifestyle management for patients with HF?
Low intensity exercise Low salt diet Smoking cessation Education Vaccination
What is the pharmacological management of patients with HF?
Diuretics ACEi B-Blockers Spironolactone Inotropic agents Nitrates Anticoagulation
What is the routine for Diuretics when treating heart failure?
1) Furosemide (40mg-80mg)
2) Change to Bumetanide if Furosemide doesn’t work
3) Add a Thiazide for complete diuresis (watch U&Es)
* Acute fluid offloading*
Why do patients on ACEi develop a dry cough?
Prevents the breakdown of Bradykinin which builds up and causes bronchospasm –> cough
Which drugs improve prognosis in HF patients?
ACEi
Spironolactone
Give an example of a drug that can be used as an alternative to ACEi in patients with HF
Losartan, Candesartan - Angiotensin II receptor antagonist
When are B blockers used for HF?
In stable and chronic patients
Initiated in patients with LV dysfunction after diuretics and ACEi used
What is a complication of Ramipril?
Dry cough
AKI
What is a complication of B blockers?
Claudication in patients with PAD
What are some of the side effects of Spironolactone?
Hyperkalaemia
Gynacomastia
Which group of patients would benefit from Digoxin treatment?
Those with HF and AF
Patients with severe HF and no other conventional treatments have been effective
What are some of the side effects of Digoxin?
Xanthopsia (Yellow vision, esp in patients with renal failure)
Reverse tick in ST segment on ECG
When are Inotropic agents (eg Dobuatmine) used?
Support myocardial function in patients with acute LVF with hypotension
What is important about the administration of Nitrates?
Tolerance develops with chronic use so administered BD
Why is anticoagulation considered in HF patients?
4x increase risk of stroke
Underlying arrhythmia causing HF may also increase risk of stroke
What is the non pharmacological management of HF?
Revascularisation
Biventricular pacemaker
Implantable cardioverter defibrillator (ICD)
Cardiac transplant
Left ventricular assist device (LVAD)
May depend on the underlying cause of the HF
Superior Vena Cava Obstruction has a raised JVP, what is difference between this and a raised JVP in RHF?
The JVP is fixed in SVCO and is not in RHF
What is a complication of Aspirin that may cause HF?
Microcytic anaemia
What drug can cause Lupus?
Hydralazine
