Heart Failure Flashcards
What is heart failure?
A clinical syndrome comprising of dyspnoea, fatigue or fluid retention due to cardiac dysfunction
What are 4 clinical risk factors of chronic heart failure?
Hypertension
Diabetes
Obesity
Coronary heart disease
What are 3 symptoms of heart failure?
Breathlessness
Fatigue
Oedema
What are 4 signs on examination of heart failure?
Tachycardia Raised JVP Chest crepitations/effusions 3rd heart sound Displaced/abnormal apex beat
What are 2 screening tests that can be performed for heart failure?
ECG
BNP (brain natriuretic peptide) measurement
How does BNP react in heart failure?
BNP is elevated
What condition of heart failure is unlikely with a normal ECG?
Left ventricular systolic dysfunction
What investigation should be performed when an elevated BNP is identified?
ECHO
What do structural cardiac abnormalities usually lead to?
Heart Failure
What are the 4 primary causes of LVSD?
Ischaemic heart disease
Aortic valve disease
Mitral regurgitation
Dilated cardiomyopathy (all secondary causes not related to IHD or valves)
How can disease affect the LV ejection fraction?
Can either increase or decrease it
What investigation can be used to determine LV ejection fraction?
ECHO
What percentage is a severe LV ejection fraction?
What scan other than ECHO can be used to identify LV ejection fraction?
MUGA scan
What is it is involved in systolic heart failure?
Decreased pumping function resulting in fluid back up in lungs and heart failure?
What is it is involved in diastolic heart failure?
The heart muscle thickens and becomes stiff causing the heart not to fill with blood properly resulting in fluid backup of the lungs and heart failure
What are the 2 (salt and waters retaining and vasoconstriction) systems involved in the neuroendocrine response to heart failure?
The renin-angiotensin-aldosterone system
The sympathetic system
What are the 2 (salt and waters excretion and vasodilation) systems involved in the neuroendocrine response to heart failure?
Natriuretic peptide system
ERDF
What are the 3 drugs that are used to improve the symptoms of heart failure?
Diuretics
Digoxin
ACE inhibitors/ARBs
What are the 4 drugs that are used to improve the survival of heart failure?
ACE inhibitors/ARBs
B Blockers
Ivabradine
Spironolactone`
What are the 3 aims of symptomatic treatment of heart failure?
Inhibition of detrimental neurohormonal adaptions
Enhancement of beneficial neurohormonal adaptions
Enchancement of cardiac function
What is the main drug type for symptomatic treatment of heart failure?
Loop diuretics
What is the main drug used for loop diuretics?
Furosemide
What are 4 adverse drug reactions of loop diuretics?
Dehydration
Hypotension
Hypokalaemia
Gout
What drugs should furosemide not be used with? (5)
Aminoglycosides Lithium NSAIDs Antihypertensives Vancomycin
What is spironolactone an example of?
An aldosterone antagonist
What should spironolactone be used with to reduce mortality of heart failure patients?
ACEI
When should B blockers be used in heart failure?
Once a patient has been stabilised not during acute presentation (and only by specialists)
What are 2 examples of B blockers
Carvedilol
Bisoprolol
Metoprolol
What is the typical therapeutic regime (in order) for treating heart failure?
Furosemide (loop diuretic)
ACEI
B blocker
(Digoxin or Warfarin in special cases)
