Heart Failure Flashcards
What is the pathology of heart failure?
Occurs when heart unable to pump blood at a rate required by metabolising tissues
What are the compensatory mechanisms of decreased cardiac output?
- Left ventricular dilation
* increases preload = increase stroke volume - Activation of sympathetic nervous system
- Increase HR
- Systemic vasoconstriction = increase BP
- Venous vasoconstriction
- Activation of renin angiotensin aldosterone system
- Sodium and water retention = increase preload and stroke volume
- Systemic vasoconstriction
What is the aetiology/risk factors of heart failure?
Main
- IHD
- Hypertension
- Cardiomyopathies
Other
- Myocarditis/endocarditis
- Thyrotoxicosis
- Electrolyte distubances
- PE
- Pregnancy
What are the symptoms of left sided heart failure?
- SOB
- Orthopnoea
- Paroxysmal nocturnal SOB
- Fatigue
- Lung crepitations
- Pleural effusions
- Cyanosis
What are the symptoms of right sided heart failure?
- Peripheral oedema
- Abdominal distension/ascites
- Hepatomegaly
- Increased JVP
- Hepatojugular reflux
What are the symptoms of severe heart failure?
- Reduced pulse pressure
- Hypotension
- Cool peripheries
- 3rd & 4th Heart Sounds
- Gallop rhythm
What is the scoring system for heart failure?
NYHA CLASSIFICATION
What is the main investigation for heart failure?
BNP LEVELS
- >400 = referral and Doppler echo w/i 2 weeks
- 100-400 = referral in 6 weeks
- <100 = unlikely HF
What are the other investigations for heart failure?
- CXR
- Echo with Doppler
- eGFr
- TFTs
- Fasting lipids
- Glucose
- Urinalysis
- Cardiac enzymes
- U&Es
What are the main treatment options for heart failure?
1st line: ACE inhibitor + beta-blocker
2nd line: Aldosterone antagonist (e.g. SPIRONOLACTONE)
OR
Angiotensin II R blocker (e.g. LOSARTAN)
OR
HYDRALAZINE + nitrate
3rd line: Digoxin
OR
cardiac resychronisation therapy
What other management can be given for HF?
- Loop diuretics for symptom relief ONLY
- Offer annual influenza vaccination
- Offer one off pneumococcal vaccine
What are the CXR signs of heart failure?
A - Alveolar shadowing (bilateral fluff round hilar)
B - Kerly B Lines
C - Cardiomegaly
D - Dilated blood vessels
E - Effusion
