Heart failure Flashcards

1
Q

What are the causes of heart failure?

A
Ischaemic heart disease
Non-Ischaemic dilated cardiomyopathy
Hypertension
Valvular disease
CHD
Arrhythmias
Pericardial disease
Alcohol/drugs
Hyperdynamic circulation (Anaemia, Thyrotoxicosis, Padgets)
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2
Q

What murmur can occur in LHF?

A

Mitral regurgitation - Displaced apex beat

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3
Q

What murmur can occur in RHF?

A

Tricuspid regurgitation - Pansystolic, V waves, Pulsatile

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4
Q

What are some of the physiological changes in HF?

A
Ventricular dilatation
Myocyte hypertrophy
Neurohumeral - Increased ANP
Salt/Water retention
Sympathetic stimulation
Peripheral vasoconstriction
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5
Q

How do you calculate CO?

A

CO = SV x HR

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6
Q

How is CO maintained in patients with heart failure?

A

Increase in venous pressure
Tachycardia
Decreased CO causes Adrenergic activation and RAAS activation

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7
Q

What is an objective measure of heart failure?

A
Ejection fraction seen on echo
Normal = >55%
Mild = 45-54%
Moderate = 35-44%
Severe =
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8
Q

What are the symptoms of LHF?

A

Fatigue
Orthopnoea/PND
Exertional dyspnoea

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9
Q

What are the signs of LHF?

A

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

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10
Q

What valvular diseases cause LHF?

A

Mitral/Aortic

Mitral stenosis causes LA HTN and signs of LV failure, but does itself not cause the LV to fail

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11
Q

What are the causes of LHF?

A

Ischaemic heart disease
Non ischaemic dilated cardiomyopathy
HTN
Mitral/Aortic valve disease

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12
Q

What are the causes of RHF?

A
Chronic lung disease (Cor Pulmonale)
PE
Pulmonary HTN
Tricuspid/Pulmonary valve disease
Left to right shunts (ASD/VSD)
Isolated RV cardiomyopathy
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13
Q

What are the symptoms of RHF?

A

Fatigue
Dyspnoea
Anorexia/Nausea

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14
Q

What are the signs of RHF?

A
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
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15
Q

What investigations would you perform in a patient with suspected heart failure?

A

Bloods - FBC, ANP/BNP, LFT, U&Es
CXR
Echocardiogram

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16
Q

What is the NYHA HR classification - Class I?

A

No limitation of physical activity

17
Q

What is the NYHA HR classification - Class II?

A

Slight limitation of physical activity - Symptomatically mild heart failure

18
Q

What is the NYHA HR classification - Class III?

A

Marked limitation of physical activity - Symptomatically moderate heart failure

19
Q

What is the NYHA HR classification - Class IV?

A

Symptoms at rest - Symptomatically severe heart faulure

20
Q

What is the general lifestyle management for patients with HF?

A
Low intensity exercise
Low salt diet
Smoking cessation
Education 
Vaccination
21
Q

What is the pharmacological management of patients with HF?

A
Diuretics
ACEi
B-Blockers
Spironolactone
Inotropic agents
Nitrates
Anticoagulation
22
Q

What is the routine for Diuretics when treating heart failure?

A

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*

23
Q

Why do patients on ACEi develop a dry cough?

A

Prevents the breakdown of Bradykinin which builds up and causes bronchospasm –> cough

24
Q

Which drugs improve prognosis in HF patients?

A

ACEi

Spironolactone

25
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
26
When are B blockers used for HF?
In stable and chronic patients | Initiated in patients with LV dysfunction after diuretics and ACEi used
27
What is a complication of Ramipril?
Dry cough | AKI
28
What is a complication of B blockers?
Claudication in patients with PAD
29
What are some of the side effects of Spironolactone?
Hyperkalaemia | Gynacomastia
30
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
31
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
32
When are Inotropic agents (eg Dobuatmine) used?
Support myocardial function in patients with acute LVF with hypotension
33
What is important about the administration of Nitrates?
Tolerance develops with chronic use so administered BD
34
Why is anticoagulation considered in HF patients?
4x increase risk of stroke | Underlying arrhythmia causing HF may also increase risk of stroke
35
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*
36
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
37
What is a complication of Aspirin that may cause HF?
Microcytic anaemia
38
What drug can cause Lupus?
Hydralazine