Heart failure Flashcards
What does late gadolinium enhancement tell you on MRI?
Shows regional but not diffuse myocardial fibrosis
means irreversible injury
BNP in heart failure
Negative rules out
Positive means need to select further tests
High levels = greater risk CV events
Can adjust treatment to reduce n peptides and MAY improve outcomes
Most cost effective in 60-75 year olds with fewer than 2 comorbidities
Main cause of diastolic heart failure
Hypertension
Rule of 2s in heart failure education
more than 2kg in 2 days call doctor
2g salt
2L fluid
High quality evidence for what 5 things in systolic heart failure?
ACEi beta blockers for II and III Angiotensin 2RB dedicated MDT Bivent pacing, AICD
What has the biggest mortality benefit?
BETA BLOCKERS
then spironolactone
then ACE/ARB
How does ivabradine work?
Acts on funny channel in SA node
in heart failure II or III with impaired systolic function less than 35% AND recent HF hosp AND HR over 70 despite max beta block/max tolerated
What does BNP do?
BNP produces arterial and venous vasodilation
Ivabradine effects/outcomes?
Reduce cardiovascular deaths/heart failure admissions
Reduce all cause hosp admissions
ANP good guy or bad guy?
Good guy!
AICD indications
Survived a VF arrest due to a not transient or reversible cause
Sustained VT and structural heart disease
LVEF under 35 percent more than one moth post MI ro three months post CAGs and nyha 2 or 3
LVEF under 35% and symptomatic CHF NYHA 2-3
not if not going to survive a year
Bivent pacing indications
Ischaemic or dilated+ NYHA 3-ambulatory 4 + LVEF +QRS over 120 + sinus + EF 35%
AF same but “reasonable”
NYHA 2 + LVEFunder30 + QRS over 150 with LBBB morphology
What do ACEi, aldo antag, beta blockers all do?
Reduce symptoms
Reverse remodelling
Reduce heart failure death and sudden death
What do diuretics and digoxin do?
Symptom benefit ONLY THING!
No mortality or remodelling benefit
MDTs do what?
Prevent clinical deterioration
Restrictive cardiomyopathy- suspect AMYLOID when
predom RHF
left ok
unexplanined increase in vent wall thickness
atria dilated and afib common
Is low EF an indication for heart transplant?
No not alone
Have to stop smoking
Hep and HIV not absolute contraindications
Morbid obesity and poor diabetes are contraind
Number one indication for heart transplant?
Idiopathic ahead of ischaemic by a bit
40%
Characteristics of transplant coronary disease vs regular coronary disease?
Diffuse
Distal
Non calcified
concentric (not eccentric)
Main benefit of a heart transplant?
Survival- mean without is under 2 years. Median ANZ is 4 years.
Stages of heart failure
Stage A- high risk of heart failure but no structural or symptom changes
Stage B- Structural heart disease without signs or symptoms
Stage C- Structural heart disease and prior or current symptoms
Stage D- Refractory heart failure
Explain E and A
E is passive ventricular filling
A is filling from the atrial kick.
EA very high in AF
Normally A is more than E
Grade 1 - abnormal relaxation with E less than A
Grade 2 - pseudonormal as the E to A looks normal
Grade 3 - restrictive filling E:A more than 3:1
Start a beta blocker, then…
Clinical deterioration first 1-2 months
Ivabradine side effects
Visual disturbance
QT looks longer because HR slows but no actual torsades effect
bradycardia
AF
DCM is from mutations in what when it is the AD form?
sarcomere genes in 30% cases
Can also have cardiac conduction system disease in LMNA mutation sin people with DCM
Alcoholic vs cirrhotic cardiomyopathy?
Alcoholic- dilated
Cirrhotic- more normal LV size
What do pacemaker codes mean?
First second third fourth fifth
1- chamber paced
- chamber sensed
- response to sensing
- Rate modulation (R= rate adaptive o=not)
- multi-site pacing
Heart transplant highest mortality
first 30 days
6-12 months
after one year
graft failure
infection
allograft vasculopathy
