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CVS > Heart failure > Flashcards

Heart failure Flashcards

1
Q

what is plasma BNP and whats it related to?

A

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

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2
Q

Heart failure

A

CO inadequate for body’s requirements

Need to have:

  1. signs + symptoms typical of HF
  2. objective evidence of an abnormality of the structure or function of the heart at rest
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3
Q

Systolic failure

A

inability of the ventricle to contract normally, resulting in decreased CO

EF

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4
Q

Diastolic failure

A

inability of ventricle to relax and fill normally
raised filling pressures
decreased preload
EF >50% (normal/near normal)

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5
Q

Causes of systolic HF

A

IHD, MI, cardiomyopathy

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6
Q

Causes of diastolic HF

A

tamponade, constrictive pericarditis, HTN

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7
Q

What is congestive cardiac failure?

A

Left ventricular failure and right ventricular failure existing together

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8
Q

Symptoms of left heart failure (LVF)

A 
Exertion dyspnoea
Paroxysmal nocturnal dyspnoea (PND)
Orthopnoea (dyspnoea when lying flat)
Fatigue
Nocturnal cough
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9
Q

Symptoms of right-sided heart failure (RVF)

A 
Peripheral oedema (ankles, sacrum)
Ascites
Nausea
Facial engorgement (filling)
Fatigue
Anorexia
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10
Q

Causes of left heart failure

A

IHD
Valvular disease
HTN

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11
Q

Causes of right heart failure

A

LVF
Pulmonary stenosis
Lung disease

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12
Q

Acute HF

A

New onset acute or decompensation of chronic heart failure characterised by pulmonary and/or peripheral oedema with or without signs of peripheral hypo perfusion

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13
Q

Chronic HF

A

develops or progresses slowly
venous congestion is common
arterial pressure well maintained until very late

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14
Q

Low output heart failure

A

CO is decreased and fails to increase normally with exertion

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15
Q

Causes of low output heart failure

A

Pump failure: systolic & diastolic HF, -ve inotropic drugs (most antiarrhythmics)
Excessive preload: mitral regurgitation, fluid overload
Chronic excessive after load: aortic stenosis, HTN

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16
Q

Whats high output HF?

A

rare, normal output: but increased needs

causes: anaemia, pregnancy, hyperthyroidism, paget’s disease

17
Q

Criteria name for diagnosis of congestive cardiac failure?

A

Framingham criteria

18
Q

ABCDE for CXR in left ventricular failure

A 
A - Alveolar oedema ('Bat's' wings)
B - Kerley B lines (insterstial oedema)
C - cardiomegaly
D - Dilated prominent upper lobe vessels
E - pleural effusion
19
Q

LHF signs

A 
cardiomegaly
3rd & 4th heart sounds
tachycardia
crepitations in lung bases
pleural effusion
20
Q

RHF signs

A

raised JVP
hepatomegaly
pitting oedema
ascites

21
Q

Other signs of HF

A

exhaustion, cool peripheries, cyanosis, low BP…

22
Q

HF investigations

A

ECG - may indicate cause
BNP

if either is abnormal –> echo
(if both normal: HF unlikely)

CXR
Bloods

23
Q

Chronic HF management

A

Stop smoking, lower salt intake, optimise weight + nutrition

treat cause
treat exacerbating factors
avoid exacerbating factors (e.g. NSAIDs - fluid retention)

24
Q

A loop diuretic for chronic HF management

A

furosemide

25
Q

An ACE-i for chronic HF management

A

ramipril

26
Q

an ARB

A

Candesartan

candy and tartan

27
Q

A beta-blocker

A

Carvedilol

28
Q

What is spironolactone?

A

an aldosterone antagonist

29
Q

Name 2 vasodilators

A

Hydrazine & isosorbide dinitrate (HID)

30
Q

Acute HF management

A 
oxygen
monitor ECG - treat any arrhythmias
Diamorphine IV
Furosemide IV
GTN spray
31
Q

LOON pneumonic for acute HF management

A

Loop diuretic (furosemide)
Oxygen
Opiod (diamorphine)
Nitrates (GTN)

32
Q

Complications of HF

A 
renal failure (as not perfusing kidney properly)
hepatic dysfunction
arrhythmia
33
Q

What is the NYHA?

A

New York Heart Association Classification

Relies on functional class. What the pt can do without getting heavy or tired

34
Q

Classes I - IV of the NYHA

A

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)

35
Q

What does Ivabradine do?

A

blocker of the If current in the SA node
slows sinus node rate
agent for treating angina
(iv a brad - housemate)

36
Q

What to do if HF with preserved LV EF?

A

give diuretics to deal with confession

treat any cardiovascular problem

37
Q

Surgery and HF

A

mitral valve repair
aortic valve replacement
mitral valve replacement
LV re-modelling

38
Q

When would you use an ARB?

A

if an ACE-i is contraindicated or due to side effects

CVS (14 decks)

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