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Cardiology > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is it cardiac failure?

A

CHF is essentially an impairment of the ability of the left ventricle to fill with or eject blood. It’s divided into two main types:
1/ Systolic heart failure – LVEF <40%
2/ Heart failure with preserved systolic function (diastolic heart failure) where LVEF is >40% but there is evidence of impaired relaxation and/or raised filling pressure.

Ref: https://foam4gp.com/2013/11/11/foam4gp-map-while-the-fe-is-hot/

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2
Q

Causes of Systolic Heart Failure

A

> > Most common
coronary heart disease & previous history of AMI
HTN
idiopathic dilated cardiomyopathy (less common)

> > Less common causes
Valvular incompetance, Aortic Stenosis / MR
Non ischemic dilated cardiomyopathy (etoh)
Inflammatory cardiomyopathy (e.g. myocardiits)
Drug induced cardiomyopathy (e.g. cylophosphamide)
thyroid disorders

hyper/hypothyroidism

(Ref: FOAM4GP)

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3
Q

What symptoms might my patients present with?

A 
Exertional Dyspnoea
Orthopnoea 
Paroxysmal noctural dyspnoea or nocturnal cough
Fatigue
Dry irritating cough 
Palpitations / syncope / dizziness
Weight gain or loss
Peripheral oedema

Non specific symptoms - “I just don’t feel right”.
(Ref: FOAM4GP)

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4
Q

Risk factors for heart failure?

A 
cardiovascular disease
hypertension
diabetes
valve disease
cardiomyopathy
excessive ETOH
smoking.
(Ref: FOAM4GP)
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5
Q

How common is it?

A

Chronic heart failure is common, affecting 1.5-2% of Australians.
(Ref: FOAM4GP)

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6
Q

Classification is based on the New York Heart Association system, categorised based on functional limitation:

A

Class I No limitations, ordinary physical activity does not cause undue fatigue, dyspnoea or palpitations (asymptomatic LV dysfunction). 5% 1 year mortality.

Class II Slight limitation of physical activity, ordinary physical activity results in fatigue, palpitation, dyspnoea, or angina (Mild CHF). 10% 1 year mortality.

Class III Marked limitation of physical activity. Less than ordinary physical activity causes symptoms (moderate CHF). 20% 1 year mortality.

Class IV Unable to carry on any physical activity without discomfort. Symptoms of CHF present at rest (severe CHF). 50% 1 year mortality.

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7
Q

When are implantable defib’s indicated?

? biventricular pacing

A

Implantable device
LVEF < 35% + symptmatic
LVEF <30% and MI
VF/VT Arrest

Biventricular pacing page 38)
NY III or IV
QRS > or equal to 120ms
Dilated heart failure with LVEF <35%

(Check Cardiology 2016)

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8
Q

Causes of diastolic heart failure (impaired relaxation)

A

> > Common causes
Hypertension (especially systolic hypertension). Patients
CHD, which may lead to impaired myocardial relaxation.
Diabetes—

Less common causes
• Valvular disease, particularly aortic stenosis.
Uncommon causes
•Hypertrophic cardiomyopathy—most cases are hereditary.
•Restrictive cardiomyopathy, either idiopathic or secondaryto infiltrative disease, such as amyloidosis

(ref: Heart foundation)

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9
Q

Pharmacological management

A

Ace I

  • -> Recommended for all patients with systolic heart failure (LVEF<40%) in mild, mod, severe symptoms
  • -> optimal dose not determined

AII Antagonist

  • -> Recommended as an alternative for patients with ACE-I mediated cough
  • -> survival benefit in CHF, not after AMI

BBlocker (when pt is stable)
–> survival benefit after MI, stops progression of symptoms

Aldosterone antagonist (Spironolactone)

  • -> Recommended for patients that are severely symptomatic despite appropriate doses of ACEI and diuretics
  • -> not if eGFR<30
  • -> survival benefit

Digoxin
- no mortality benefit, consider 1st line in AF

(Ref: Heart foundation)

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10
Q

Aim for
1/ salt intake per day
2/fluid intake per day

A

1/ 2g/day
2/ 2L day
(ref: FOAM4GP)

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11
Q

Examples of drugs that exacerbate heart failure

A 
calcium channel blockers,
NSAIDs 
tricyclic antidepressants
corticosteroids
Clozapine  
TCA

(Ref: Cardiology Check)

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12
Q

T or F:

Angiotensin II antagonist has a survival benefit in congestive heart failure but not for heart failure after acute MI

A

True

Ref: heart foundation guidelines

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13
Q

Which calcium channel blockers are contraindicated in systolic heart failure?

A

Non dihydropyridines - diltiazem, verapamil

Ref: heart foundation guidelines

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14
Q

Do Dihydropyridines have a survival benefit in systolic heart failure?

A

Amlodipine → Nil survival benefit in systolic CHF, nil adverse outcomes, can use for comorbidities e.g. HTN
(Ref: heart foundation guidelines)

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15
Q

What are the contraindications for sildenafil & other phosphodiesterase V inhibitors?

A
  • patients receiving nitrate therapy
  • hypotension
  • arrhythmias
  • angina pectoris

–> Sildenafil and other phosphodiesterase V inhibitors are generally safe in patients with heart failure.

(Ref: heart foundation guidelines)

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16
Q

Which are the three most common BBblockers used in Cardiac Failure?

A

b1 selective antagonist

  • Bisoprolol
  • Metoprolol extended release

b1,b2,alpha1 antagonis
- Carvedilol –> prolong survival in patients with severe sx)

(ref: heart foundation p28)

17
Q

What is the non pharmacological management for cardiac failure?

A

S - quit smoking
N
1. Sodium
mild symptoms (i.e. clinically stable, NYHA Class II and no peripheral oedema → 3g/day)

moderate to severe symptoms (NYHA Class III/IV) requiring a diuretic regimen→ restricted intake of 2g/day

  1. Caffeine → 1-2/day
  2. Fluid management
    <2L/day
    Monitor weight → if >2kg gain → contact doctor
    2L/day
    If fluid retention → 1.5L/day

A - Etoh → not more than 2/day
P - physical activity Meta-analyses RCT’s –> overall reduction in mortality, an increase in combined survival and hospital-free periods, and reduction in hospitalisation (ref: heart foundation page 21)

Vaccination → influenza, pneumococcal

(ref: Heart foundation guideline)

18
Q

When is a BNP useful?

A

ifan echocardiogram cannot be arranged in a timely fashion plasma BNP measurement may be useful.
A low BNP level(<100 ng/L) makes the diagnosis of heart failure unlikely

(Ref Check Heart Health, 2014)

19
Q

Which medications have a survival benefit in heart failure?

A

ACE I
BBlocker
Spironolactone

(Ref Check Heart Health, 2014)

20
Q

Does Digoxin have a survival benefit in Heart Failure?

A

Nil reduction in Mortality
Reduces Hospitalisations
Maintains Stability and Exercise Capacity
(Ref Check Heart Health, 2014)

21
Q

Is Atenolol approved for use in heart failure?

A

NO

Cardiology (19 decks)

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