Heart failure Flashcards
How is heart failure defined?
When cardiac output is inadequate for the body’s requirements
What happens in systolic failure?
Inability of the ventricles to contract normally
Decreased cardiac output
Ejection fraction is less than 40%
Left ventricular failure can produce what symptoms?
Dyspnoea, orthopnoea and PND Fatigue Nocturnal cough Wheeze Weight loss
Right ventricular failure can produce what symptoms?
Peripheral oedema
Nausea
Anorexia
Pulsation in neck and face
What are the main signs of heart failure?
Oedema (peripheral and pulmonary) Tachycardia Raised JVP Chest crepitations/effusions 3rd heart sound Displaced or abnormal apex beat
What are the 4 main screening tests for heart failure?
12 lead ECG
Brain natriuretic peptide (If HF, levels are high in blood)
Echo (can indicate the cause, confirms LV dysfunction absence or presence)
CXR (Could show cardiomegaly)
Which part of neurohormnal activation causes increased sodium reabsorption and vasoconstriction?
RAA system
ADH production
What is the effect of salt and water retention on blood pressure?
Increases BP
What are the 2 main aims of heart failure treatment?
To improve symptoms
To improve survival
What are the aims of symptommatic treatment?
Inhibition of the detrimental neurohormonal adaptations
Enhacement of beneficial neurohormonal adaptations
Enhances cardiac function
How do ACEIs/ARBs work?
Block the effects of angiotensin II
Give an example for a diuretic
Furosemide
What does digoxin do?
Improves the pumping ability of the heart, which improves the cardiac function
What do vasodilators reduce?
Preload
Afterload
What will spironolactone block the effects of?
Aldosterone
What are the main adverse drug reactions of diuretics?
Dehydration
Hypotension
Gout
Impaired glucose tolerance
When the patient is given ACEIs, how else can the body convert angiotensin I into angiotensin II?
Through the enzyme, chymase
Give an example of an ACEI
Ramipril
Enalapril
What are the ADRs of ACEIs?
Hypotension
Cough
Renal failure
How are ARBs more effective than ACEIs?
ARBS selectively block the AT1 receptor, where as ACEIs do not and could block the AT2 receptor
How do beta-blockers work?
Block the action of the sympathetic system
When is the only time beta-blockers are used in heart failure?
Only used when patient is stabilised
How does ivabradine decrease HR?
Inhibits conduction from the SA node
Why are anti-coagulants used in heart failure?
To prevent formation of thrombus
