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Cardiovascular - exam style qs > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Definition of heart failure

A

A clinical syndrome comprising of dyspnoea, fatigue or fluid retention due to cardiac dysfunction, either at rest or on exertion, with accompanying neurohormonal activation

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2
Q

Symptoms

A

Dyspnoea
Fatigue
Oedema
Reduced exercise capacity

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3
Q

Signs

A 
Oedema
Tachycardia
Raised JVP
Chest crepitations or effusions
3rd heart sound
Displaced or abnormal apex beat
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4
Q

3 things patient must have to diagnose heart failure

A
  1. symptoms or signs of HF
  2. Objective evidence of cardiac dysfunction
  3. Response to therapy (diuretics)
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5
Q

How can you get objective evidence of cardiac dysfunction

A 
Echocardiography
Radionuclide ventriculography
MRI
ECG
BNP (brain natriuretic peptide)
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6
Q

what could be used as a potential screening test for heart failure

A

elevated BNP

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7
Q

What 3 causes of heart failure to remember

A

Ischaemic heart disease
Dilated cardiomyopathy - Left ventricular systolic dysfunction
Severe aortic valve disease or mitral regurgitation

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8
Q

What would you try and identify and quantify in an echocardiography

A

LV systolic dysfunction
Valvular dysfunction
Pericardial effusion/ tamponade
Diastolic dysfunction
Left ventricular hypertrophy
Atrial/ventricular shunts/ complex congenital heart defects
Pulmonary hypertension/ right heart dysfunction

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9
Q

What is the LV ejection fraction

A

Stroke volume over end diastolic volume

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10
Q

Normal, mild, modertate and severe LV ejection fractions

A

Normal: 50-80%
Mild: 40-50%
Moderate: 30-40%
Severe: <30%

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11
Q

How might you find out the LVEF

A

Biplane Modified Simpson’s Rule
Radionucliotide angiography
Cardiac MRI

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12
Q

Grading of hypertrophy based on New York Association classification

A

I - No limitation, no symptoms during usual activity
II - Mild limitation, comfortable with rest or mild exertion
III - moderate limitation, comfortable only at rest
IV - severe limitation, any physical activity brings on discomfort and symptoms occur at rest

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13
Q

Why can someone with HF have same cardiac output as some

A

Dilated heart so larger end diastolic volume but smaller percentage of stroke volume
Also more bpm

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14
Q

How do neurohormonal changes come into heart failure?

A

Renin-angiotensin-aldosterone system is activated and salt and water is retained

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15
Q

Effects of the renin-angiotensin-aldosterone system in heart failure

A

Salt and water retention
Adverse haemodynamics
LV hypertrophy/remodelling and fibrosis
Hypokalemia and hypomagnesaemia

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16
Q

Heart failure definition (other lecture)

A

A state in which the heart is unable to pump blood at a rate commensurate with the requirements of the tissues or can do so only from high pressures

17
Q

Risk factors for heart failure

A 
Coronary artery disease
History of previous MI
Hypertension
Valvular heart disease
Alcoholism
Diabetes
Congenital heart defects

Obesity
Age
Reduced or falling vital capacity
Smoking

18
Q

What happens to cardiac myocytes as the heart starts to dilate

A

They undergo hypertrophy and then fibrosis and the heart is further weakened

19
Q

What does the sympathetic system do in heart failure

A

Causes the release or noradrenaline and adrenaline

  • vasoconstriction
  • stimulate renin release
  • myocyte hypertrophy
20
Q

Two aims of treatment

A

To improve symptoms

To improve survival

21
Q

What two drugs improve symptoms

A

Diuretics

Digoxin

22
Q

What 3 drugs improve symptoms and survival

A

ACE inhibitors/ ARBS
Spironolactone
Valsatan-sacubitril

23
Q

What 2 drugs improve survival

A

Beta-blockers

Ivabradine

24
Q

Give an example of a loop diuretic and what does it do?

A

FUROSEMIDE

Removes excess salt and water by inhibiting the sodium/potassium/chlorine transporter in the Loop of Henle

25
Q

Adverse drug reactions with diuretics

A

Dehydration
Hypotension
Gout
Hypokalaemia

26
Q

Give an example of an ACE inhibitor and what does it do

A

Ramapril, Enalapril, Lisinopril
Competitively blocks the angiotensin converting enzyme to reduce preload and afterload on heart therefore reduce blood pressure

27
Q

Adverse drug reactions

A

First dose hypotension
Cough
Renal impairment
Renal failure

28
Q

What would be an alternative to lower blood pressure if intolerant to ACE inhibitors

A

Angiotensin receptor blockers such as Valsartan-Sacubitril

29
Q

What is spironolactone

A

An aldosterone antagonist

30
Q

Example of beta blockers for heart failure

A

Bisoprolol
Carvedilol
Metoprolol

31
Q

How are beta blockers used in heart failure?

A

Only used by specialists

Blocks the actions of the sympathetic system, lowers heart rate

32
Q

What does Ivabradine do?

A

Specific inhibitor of the If current in the sinoatrial node

33
Q

Example of a positive intrope

A

Digoxin

34
Q

Example of an anticoagulant

A

Warfarin

35
Q

Therapeutic regime round up

A 
Furosemide 
ACE inhibitor
Angiotensin receptor blocker
ARNI
Beta blocker and Ivabradine
Digoxin
Warfarin

Cardiovascular - exam style qs (20 decks)

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