Heart failure Flashcards
what is plasma BNP and whats it related to?
B-type natriuretic peptide
polypeptide secreted by the ventricles of the heart in response to excessive stretching of cardiomyocytes
secreted from the ventricular myocardium + closely related to LV pressure
In MI and LV failure, can be released in large quantities
Heart failure
CO inadequate for body’s requirements
Need to have:
- signs + symptoms typical of HF
- objective evidence of an abnormality of the structure or function of the heart at rest
Systolic failure
inability of the ventricle to contract normally, resulting in decreased CO
EF
Diastolic failure
inability of ventricle to relax and fill normally
raised filling pressures
decreased preload
EF >50% (normal/near normal)
Causes of systolic HF
IHD, MI, cardiomyopathy
Causes of diastolic HF
tamponade, constrictive pericarditis, HTN
What is congestive cardiac failure?
Left ventricular failure and right ventricular failure existing together
Symptoms of left heart failure (LVF)
Exertion dyspnoea Paroxysmal nocturnal dyspnoea (PND) Orthopnoea (dyspnoea when lying flat) Fatigue Nocturnal cough
Symptoms of right-sided heart failure (RVF)
Peripheral oedema (ankles, sacrum) Ascites Nausea Facial engorgement (filling) Fatigue Anorexia
Causes of left heart failure
IHD
Valvular disease
HTN
Causes of right heart failure
LVF
Pulmonary stenosis
Lung disease
Acute HF
New onset acute or decompensation of chronic heart failure characterised by pulmonary and/or peripheral oedema with or without signs of peripheral hypo perfusion
Chronic HF
develops or progresses slowly
venous congestion is common
arterial pressure well maintained until very late
Low output heart failure
CO is decreased and fails to increase normally with exertion
Causes of low output heart failure
Pump failure: systolic & diastolic HF, -ve inotropic drugs (most antiarrhythmics)
Excessive preload: mitral regurgitation, fluid overload
Chronic excessive after load: aortic stenosis, HTN
Whats high output HF?
rare, normal output: but increased needs
causes: anaemia, pregnancy, hyperthyroidism, paget’s disease
Criteria name for diagnosis of congestive cardiac failure?
Framingham criteria
ABCDE for CXR in left ventricular failure
A - Alveolar oedema ('Bat's' wings)
B - Kerley B lines (insterstial oedema)
C - cardiomegaly
D - Dilated prominent upper lobe vessels
E - pleural effusionLHF signs
cardiomegaly 3rd & 4th heart sounds tachycardia crepitations in lung bases pleural effusion
RHF signs
raised JVP
hepatomegaly
pitting oedema
ascites
Other signs of HF
exhaustion, cool peripheries, cyanosis, low BP…
HF investigations
ECG - may indicate cause
BNP
if either is abnormal –> echo
(if both normal: HF unlikely)
CXR
Bloods
Chronic HF management
Stop smoking, lower salt intake, optimise weight + nutrition
treat cause
treat exacerbating factors
avoid exacerbating factors (e.g. NSAIDs - fluid retention)
A loop diuretic for chronic HF management
furosemide
An ACE-i for chronic HF management
ramipril
an ARB
Candesartan
candy and tartan
A beta-blocker
Carvedilol
What is spironolactone?
an aldosterone antagonist
Name 2 vasodilators
Hydrazine & isosorbide dinitrate (HID)
Acute HF management
oxygen monitor ECG - treat any arrhythmias Diamorphine IV Furosemide IV GTN spray
LOON pneumonic for acute HF management
Loop diuretic (furosemide)
Oxygen
Opiod (diamorphine)
Nitrates (GTN)
Complications of HF
renal failure (as not perfusing kidney properly) hepatic dysfunction arrhythmia
What is the NYHA?
New York Heart Association Classification
Relies on functional class. What the pt can do without getting heavy or tired
Classes I - IV of the NYHA
I: no limitation (asymptomatic)
II: slight limitation (mild HF)
III: marked limitation (moderate HF)
IV: inability to carry out any physical activity without discomfort (severe HF)
What does Ivabradine do?
blocker of the If current in the SA node
slows sinus node rate
agent for treating angina
(iv a brad - housemate)
What to do if HF with preserved LV EF?
give diuretics to deal with confession
treat any cardiovascular problem
Surgery and HF
mitral valve repair
aortic valve replacement
mitral valve replacement
LV re-modelling
When would you use an ARB?
if an ACE-i is contraindicated or due to side effects
