Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

5. Cardiology > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

List 6 symptoms of heart failure.

A 
Dyspnoea
Orthopnoea
PND (paroxysmal nocturnal dyspnoea)
Dry cough
Peripheral oedema
Fatigue/tiredness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

List 6 signs of heart failure, e.g. what you would find in a cardiac exam.

A 
Peripheral oedema (ankles, sacrum)
Elevated JVP
Third heart sound
Displaced apex beat
Lung crepitations (indicating pulmonary oedema)
Pleural effusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Outline the classification of heart failure.

A

Class I - no symptoms

Class II - mild

  • Mild angina, mild SOB
  • Slight limitations to ordinary activity

Class III - moderate

  • Marked limitation in activity
  • Comfortable only at rest

Class IV - severe

  • Severe limitation in activity
  • Symptomatic even at rest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List 5 common causes of heart failure in the UK.

A 
Coronary artery disease (MI)
Hypertension
Idiopathic
Toxins (e.g. alcohol, chemotherapy)
Genetics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List 6 less common causes of heart failure in the UK.

A 
Valve disease
Infections
Congenital heart disease
Metabolic causes (e.g. haemochromatosis, thyroid disease)
Pericardial disease
Endocardial disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the 4 types of heart failure?

A

HF-REV (reduced ejection fraction)

HF-PEV (preserved ejection fraction)

Chronic/congestive HF

Acute/decompensated HF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the features of HF-REV compared to HF-PEV?

A

HF-REV:

  • More common in young males
  • Often caused by CAD

HF-PEV:

  • More common in elderly females
  • Often caused by hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What 4 investigations would you do in heart failure?

What 7 blood tests would you request?

A

ECG
CXR
Echo

Bloods, including:

  • U&Es
  • LFTs
  • FBC
  • Troponin
  • Thyroid function tests
  • Haemoglobin
  • Natriuretic peptides
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the surgical treatment of mild-moderate heart failure?

A

Devices, e.g.

  1. Pacemaker (ICD)
  2. Cardiac resynchronisation therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the surgical treatment of severe heart failure?

A
  1. Cardiac resynchronisation therapy (biventricular pacing)
  2. Ventricular assist devices (LVAD)
  3. Heart transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are inotropic drugs?

What are positive inotropes?

What are negative inotropes?

A

Drugs which affect strength of heart contraction

POSITIVE inotropes INCREASE strength of contractility

NEGATIVE inotropes DECREASE strength of contractility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

List, in order, the treatment of heart failure with reduced ejection volume (HF-REV). (9)

A
  1. Diuretics
  2. Beta blockers and ACE inhibitors
  3. Add MRA (aldosterone antagonist)
  4. Start sucubitril/valsartan (ARB plus neprilysin inhibitor)
    a. STOP ACE inhibitors and ARBs
  5. Add ivabradine (sinus node inhibitor)
  6. ICD (pacemaker) or cardiac resynchronisation therapy (CRT)
  7. Digoxin
  8. Hydralazine isosorbide dinitrate
  9. Heart transplant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

List 2 examples of MRAs (aldosterone antagonists).

A

Spironolactone

Eplerenone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

List 2 examples of beta blockers used in heart failure.

A

Carvedilol

Bisoprolol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List 1 example of an ACE inhibitor used in heart failure.

A

Perindopril

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

List 2 examples of ARBs used in heart failure.

A

Candesartan

Valsartan

17
Q

What type of drug is sucubitril/valsartan?

Describe its mechanism of action. (3)

A

ARB plus neprilysin inhibitor

MECHANISM OF ACTION:
1. Valsartan - angiotensin receptor blocker (prevents vasoconstriction)

  1. Sucubitril - neprilysin inhibitor
    a. Normally, neprilysin degrades natriuretic peptides
    b. When this is inhibited, there are more natriuretic peptides
    c. Therefore more vasodilation
18
Q

Which 2 medications do you need to stop when you prescribe sucubitril/valsartan?

A

ACE inhibitors

ARBs

19
Q

What type of drug is ivabradine?

Describe its mechanism of action. (1)

List 2 other indications.

A

Sinus node inhibitor

MECHANISM OF ACTION:
1. Inhibits If current propagation in SAN

INDICATIONS:
When beta blockers are contraindicated, e.g.
-Hypertension
-Peripheral vascular disease

20
Q

What is cardiac resynchronisation therapy?

A

Biventricular pacing

21
Q

What is an ICD?

A

Implantable cardioverter defibrillator

22
Q

Describe the mechanism of action of digoxin. (4)

A
  1. Inhibits Na+/K+ pump, causing increased intracellular Na+
  2. This causes increased activity of Na+/Ca2+ exchanger to remove Na+
    a. This causes increased levels of intracellular Ca2+
  3. This has a positive inotropic effect, i.e. increases strength of contraction
  4. This also decreases rate of conduction through AVN
23
Q

What type of drug is hydralazine isosorbide dinitrate?

Describe its mechanism of action. (2)

A

Hydralazine - vasodilator
Isosorbide dinitrate - nitrate

MECHANISM OF ACTION:
1. Hydralazine causes vasodilation

  1. Isosorbide dinitrate is converted to NO, which causes vasodilation
24
Q

Describe the pathophysiology of heart failure. (5)

A
  1. Myocardial injury causes left ventricular systolic dysfunction
  2. This causes a perceived decrease in circulating volume/pressure
  3. This causes neurohumoral activation, e.g.
    a. Sympathetic nervous system
    b. RAAS
  4. This causes haemodynamic changes, e.g.
    a. Systemic vasoconstriction
  5. This creates a cycle which keeps worsening the decreased circulating volume/pressure
25
Q

What features would you look for on an echocardiogram in heart failure? (3)

A

Chamber size
Systolic/diastolic function
Valve function

26
Q

After the diagnostic tests for heart failure (CXR, echo, bloods and ECG), which further investigations could you do? (5)

A 
Coronary angiography
Exercise tolerance test
Ambulatory ECG monitoring
Myocardial biopsy
Genetic testing
27
Q

How would you treat HF-PEV? (3)

A

No disease modifying therapy

Symptomatic management, e.g.

  • Diuretics
  • Statins
28
Q

How would you treat acute heart failure? (6)

A

MEDICAL THERAPY:

  1. Morphine
  2. Inotropic drugs (e.g. dopamine, dobutamine, milrinone)
  3. Nitrates
  4. Diuretics (frusemide)

PROCEDURES:

  1. Ultrafiltration
  2. Bileval/continuous positive airway pressure
29
Q

Apart from pharmacological therapy, which other treatment would you use for chronic heart failure? (3)

A
  1. Lifestyle factors, e.g.
    a. Smoking cessation
    b. Reduce salt intake
  2. Treat underlying cause, e.g.
    a. Arrhythmias
    b. Valve disorders
  3. Avoid exacerbating drugs, e.g.
    a. NSAIDs
    b. Verapamil

5. Cardiology (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions