Heart Failure Flashcards
Name two types of Heart Failure
HFrEF= Heart failure reduced ejection fraction HFpEF= heart failure with preserved ejection fraction
Describe HFrEF
Systolic dysfunction
Reduced capacity to pump blood out of the ventricles,
Fluid backs up into lungs
Describe HFpEF
Diastolic Dysfunction
Heart doesn’t stretch properly so reduced filling
Fluid backs up into lungs
Which renal system is activated?
RAAS
less blood leaving the heart so thinks that the body has low blood volume- leads to increases retention of water and sodium.
Symptoms of Heart Failure
Shortness of Breath- fluid in lungs
Fatigue
Oedema- fluid retention
Signs of Heart Failure
- Elevated JVP
- Oedema
- Tacycardia
- Dyspnoea
- 3rd Heart sounds
- abnormal apex beat
- cardiomegaly
Risk factors for Heart failure
Valve disease
coronary artery disease
HTN
MI
Diagnosis of HF
Signs and symptoms of heart failure PLUS Evidence of cardiac dysfunction PLUS response to diuretics (if still in doubt)
Investigations
ECHO
MUGA/ RNVG - ejection fraction
Cardiac MRI
Left ventriculography
Why measure the ejection fraction?
Can show severity 50% plus is normal 40-50% mild HF 30-40% moderate HF <30% severe HF
Screening>
ECHO- normal = not HF
ANP/BNP= elevated in HF
Treatment of HF
Loop diuretics- furosemide Thiazide type diuretics (if resistant) ACE inhibitors- ramapril ARBs- valsartan, losartan Beta blocker- carvedilol, bisoprolol Spironolactone + loop diuretic Ivabridine - slows HR Warfarin- prevention of CVA.
Two aims of HF treatment
Improve symptoms
Improve Survival
What is ARNI?
Valsartan + Neprilysin
Block AT1 receptors
Stop breakdown of ANP & BNP
What else is important for treatment?
Monitor weight and increase meds according to weight and symptoms
