Heart Failure Flashcards
To Learn About heart failure
What are the symptoms of heart failure?
- SOB
- Fatigue
- Pleural Effusion
- Inc JVP
- Third heart sound
What is acute heart failure?
Rapid onset or change in following symptoms:
- Dyspnoea
- Pulmonary or peripheral oedema
- Organ under perfusion
- Tachycardia
What is chronic heart failure?
- Chronic exercise limitation
How is ‘ ejection fraction’ used to classify HF?
- HF with preserved ejection fraction (HFPEF), or HF with a normal ejection fraction (HFNEF) - These patients have HF but no evidence of left ventricular systolic dysfunction (LVSD)
If patients have LVSD, how is HF classified?
Heart failure with LVSD commonly called systolic heart failure (SHF) - these patients have reduced left ventricular ejection fraction.
What are the pathological changes associated with HF?
Cardiac changes:
1. Structural, functional
Systemic changes:
1. Resp, Musc skel, neuroendocrine
What conditions predispose to HF?
- Acute heart failure
- Chronic heart failure
- HF secondary to high CO conditions
What acute HF conditions predispose to HF?
- Ischaemic heart disease - ACS, mechanical issues with acute MI
- Valvular - stenosis, regurgitation, endocarditis
- Circulatory failure - septicaemia, thyrotoxicosis, PE
- Decompensations of pre existing chronic HF
- Infection
How does chronic HF predispose to HF?
Conditions that damage heart muscle or limit functionality:
- Coronary heart disease
- Hypertension
- Cardiomyopathy
- Endocrine - diabetes hypo/hyperthyroidism, Cushing’s
- Sarcoidosis
- Chagas disease, HIV
What drugs increase predisposition for HF?
- Beta blockers
- Ca channel blockers
- Antiarrhythmic
- Cytotoxic agents
What high output conditions increase HF?
- Anaemia
- Thyrotoxicosis
- Septicaemia
- Liver failure
- Arteriovenous shunts
What are the clinical features of heart failure?
- SOB
- Orthopnea, paroxysmal nocturnal dyspnoea
- Fatigue
- Exercise intolerance
- Fluid retention
What are the signs of HF?
- Tachycardia
- Displaced apex beat
- Third heart sound
- Gallop rhythm
- Reduced pulse volume
- Pulsus alternans
- Raised JVP in RHF
- Oedema, basal crepitations
- Hepatomegaly
- Ascites
What investigations are used to determine HF?
- CXR
- Electro cardiography
- Biochemistry, haematology and urinalysis
- BNP, ANP and N terminal ANP
What are the ECG changes in HF?
- QRS amplitude increased
- QRS is widened
- Abnormal ST segments, ST deviation in opposite direction of QRS - discordance
What is the Modified Cornell criteria?
- If R wave in aVL > 12mm then LVH present
What are the criteria for diagnosis of HF?
- Refer patients with suspected HF and previous MI
- Measure BNP, ANP, NT ANP
- Refer patients with BNP > 400pg/ml
- Refer patients with NT - ANP > 2000
What are the differential diagnoses for classical heart failure?
- High output heart failure - volume stress
- Malignant hypertension - pressure stress
- Dyspnea
What conditions can mimic HF?
- Obesity
- Pulmonary disease
- Venous insufficiency in lower limbs
- Hypoalbuminaemia
- Depression/anxiety
- Severe anaemia/ thyroid
- Bilateral renal stenosis
How is acute left ventricular failure managed?
- Sit patient up
- IV diuretic 40-80mg frusemide
- IV opiate 5mg diamorphine
- Treat arrhythmias
- Vasodilator therapy
- Digoxin if vasodilation fails
How is acute right ventricular failure managed?
- Fluid retention
2. Controlled by measurement of pulmonary artery wedge pressure
What is the management of Chronic HF?
Treatments to reduce morbidity and mortality: 1. ACE inhibitors 2. Spironolactone 3. beta blockers Treatments to reduce symptoms: 1. Diuretics 2. Digoxin
What other treatments are considered?
Anticoagulants:
- For patients with AF
- Patients with history of thromboembolism, LV aneurysm, intracariac thrombus
Antiplatelet drugs
1. Indicated in in HF patients with atherosclerotic arterial disease (including coronary heart disease)
What are some of the complications HF?
Due to stretching of atrial fibres especially in the left atrium:
- Ventricular tachycardias common
- Arrhythmias may cause heart failure
What are the NICE guidelines for the diagnosis of HF?
- Refer patients with suspected HF and previous MI (Urgently)
- Refer patients with BNP > 400pg/mol/NTproBNP > 2000
What is NICE guidance for treatment of HF?
- Offer ACE/Beta blockers to all patients with HF due to LVSD
- Offer beta blockers to all patients with LVSD including older adults and patients with:
a. PVD
b. Erectile dysfunction
c. DMelitus
d. Interstitial pulmonary disease
e. COPD without reversibility
(LVSD - left ventricular systolic dysfunction)
