Heart Failure Flashcards
What is heart failure a general term for?
When the body’s cardiac output is inadequate for its needs
What does acute heart failure present as?
Pulmonary oedema
What does pulmonary oedema show on a CXR?
Prominent upper lobe vessels, cardiomegaly, alveolar ‘Bat’s wings’ appearance, Kerley B lines, pleural effusion
What is heart failure due to?
Failure of any part of the heart
What are two more specific causes of heart failure?
Cardiomyopathy (diseases of heart muscle) or pericardial diseases
What can cause cardiomyopathy?
Metabolic, drugs, pregnancy
What happens if the right side of the heart fails?
Back up of blood in the superior and inferior vena cava leading to congestion
What happens if the left side of the heart fails?
Congestion in the lung fields (pulmonary oedema and impaired gas exchange) and decreased CO
What can be some symptoms of heart failure?
SOB, reduced exercise tolerance, orthopnoea, PND, ankle swelling
What is systolic heart failure?
Weakness or impairment of pump
What is diastolic heart failure?
Heart is too stiff and doesn’t contract well- often caused by hypertension
What is compensated heart failure?
Patients have heart failure but are generally well
What is decompensated heart failure?
Stable patients become decompensated when they develop underlying conditions e.g. MI/arrhythmia, the disease progresses or there is a change in medication
What are some differentials of heart failure?
Anything which causes shortness of breath i.e. pneumonia/pneumothorax
How would you investigate for heart failure?
Full blood count, ABG, ECG, CXR, ECHO
How can you classify heart failure?
NYHA classification from I-IV (no limitation, slight, marked, symptoms at rest)
If the ECG is abnormal in heart failure, what will it show?
Bundle branch block- broad QRS waves, Q waves, poor R wave progression, sinus or not.
What is the treatment for chronic heart failure?
- Treat the underlying cause
- Make patients feel better (give furosemide (diuretic) if pulmonary oedema)
- Make them live longer (ACE inhibitor, beta-blocker, ARB, devices e.g. ICD
How should you prescribe ACE inhibitors?
Start at low dose and increase slowly
When should beta-blockers be given in heart failure?
When the patient is stable
What are initial risks of beta-blockers in heart failure?
Worsening dyspnoea, hypotension
What type of drug is spironolactone and when is it used?
Aldosterone receptor antagonist used in moderate-severe heart failure
What are side effects of spironolactone?
Hyperkalaemia, renal dysfunction, breast tenderness
What does ivabradine do and when is it used in heart failure?
Slows the heart rate and is used when patients are on the maximum tolerated dose of beta blocker
What are steps D and E in the acute treatment of heart failure?
Check blood glucose, oedema, patient comfort and dignity
What is a common sign of pulmonary oedema?
Pink frothy sputum
What medication do you give in acute heart failure before treating the underlying cause?
50mg IV furosemide and maybe repeat, opiates, nitrates, stop fluids
