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Cardiovascular > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Another name for heart failure? What is it? Why?

A
  • Congestive cardiac failure (CCF)
  • Syndrome - not one disease
  • Occurs due to low CO and a lot of cardiac diseases cause this
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2
Q

Types of heart failure? (2)

A
  • Left, right, mixed

* Acute, chronic

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3
Q

What do signs and symptoms of heart failure occur because of? Explain how this occurs

A
  • Due to fluid retention

* Low CO means kidneys are hypo-perfused and respond by retaining Na+ and H2O

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4
Q

Causes of left-sided CCF? (3)

What are they?

A
  • Ischaemic heart disease e.g. MI (commonest cause of LCCF)
  • Cardiomyopathy - does not contract properly
  • Valvular disease - valve regurgitation, forward CO is reduced
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5
Q

Causes of right-sided CCF? (3)

What are they?

A
  • Secondary to left heart failure (most commonly)
  • Cor pulmonale - lung disease puts strain on heart causing HF
  • Congenital heart disease
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6
Q

Symptoms of left heart failure (LVF)? (5)

What is another cause of night-time breathlessness?

A
  • Fatigue
  • Dyspnoea
  • Orthopneoa (when lie flat, fluid gathers in lungs)
  • Paroxysmal nocturnal dyspnoea (patient wakes up breathless, gets fresh air and feels better)
  • Pulmonary oedema (sudden dyspnoea and pink, frothy sputum)

Asthma

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7
Q

Clinical signs of LVF? (4)

LVF on CXR? (3)

A
  • Tachycardia
  • Fine crepitations
  • Pleural effusion – fluid underneath the lung
  • S3 (gallop rhythm = S3 + Tachycardia)

CXR

  • Cardiomegaly
  • Bats wing shadows esp. lower zones
  • Interstitial fluid
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8
Q

What are 2 possible causes of pleural effusion?

A

Lung cancer and LVF

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9
Q

Where does fluid gather in LVF? RVF?

A
  • LVF - lungs

* RVF - produces signs in ankles, stomach (ascites), liver (hepatomegaly) and neck (JVP)

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10
Q

Symptoms of right heart failure? Clinical signs? (4) CXR?

A
  • Oedema

Signs

  • Oedema (ankle/sacral)
  • JVP elevated (>4cm above sternal angle)
  • Hepatomegaly
  • Ascites

CXR
* Normal

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11
Q

What does treatment of CCF depend on? Examples of treatments? (4)

A
  • Underlying cause

Treatments

  • Previous MIs, cardiomyopathies - standard medical therapy for CCF
  • Cor Pulmonale - Diuretics and oxygen only
  • Valvular disease - valve replacement surgery
  • Fast AF - digoxin or DC shock
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12
Q

Why is fast atrial fibrillation a problem? What drug is used to treat this? What is its effect?

A
  • Makes ventricle beat too quickly, so does not have time to fill before it empties - reduced CO
  • Digoxin
  • Blocks transmission between atria and ventricle so ventricle beats at around 80 bpm
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13
Q

Standard medical treatment for CCF? (9)

A
  • Diuretics to excrete retained fluid
  • ACEIs
  • Beta Blockers
  • Spironolactone (severe cases only)
    ……………………………………………………………
    (less commonly used)
  • Digoxin
  • Other vasodilators (nitrates, hydralazine)
    ……………………………………………………………
    (unique devices and treatments used in rare cases)
  • Implantable Cardiac Defibrillators
  • Cardiac Resynchronisation Therapy
  • Transplantation
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14
Q

What diuretics are used for CCF? (2) Example? Complication of diuretics? Solution?

A
  • Thiazide diuretics for mild CCF only
  • Loop diuretics commoner
  • e.g. Furosemide
  • Lose K+ along with Na+ and H2O
  • Often used alongside ACEIs and spironolactone which help retain and normalise K+
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15
Q

Side effects of ACEIs? (4)

Alternative to ACEIs?

A
  • IMPORTANT - angioneurotic oedema (life-threatening but rare)
  • Hypotension esp. if serum Na low
  • Renal Impairment – UE must be monitored after AECI begun
  • Dry cough
  • Angiotensin II receptor blockers (ARBs) - used if cough is intolerable
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16
Q

How are B-blockers used in CCF? (2) Short term risks of B-blcokers? (2)
Examples of B-blockers? (2)

A
  • Good in long term CCF
  • Can worsen CCF in short term so start with low lose and increase slowly (start low, go slow)

Short-term Risks

  • Hypotension
  • Worsening dyspnoea

E.g.

  • Bisoprolol (B1 selective)
  • Carvedilol (non-selective plus alpha blockade)
17
Q

What is spironolactone? When/how is it used?

A
  • Aldosterone receptor antagonist

* Use in moderate/severe CCF alongside ACEI

18
Q

Side effects of sprionolactone?

A
  • Hyperkalaemia – increases K+ (K+ may go too high as used alongside ACEIs which also increase K+)
  • Renal Dysfunction
  • Gynaecomastia
19
Q

How is hyperkalaemia caused by sprionolactone avoided? What is gynaecomastia? How does this occur?

A
  • Often use spironolactone, ACEI and furosemide together (furosemide decreases K+ so often balances out)
  • Male breast growth
  • Spironolactone not only blocks aldosterone receptor but also has anti-androgen effect, and so blocks male hormones
20
Q

What is ivabradine used for? What is its effect? When is it used?

A
  • Used for CCF and angina
  • Slows HR (in sinus rhythm only)
  • Only used if HR fast despite B-blockers
21
Q

What is Sacubitril-Valsartan? What is its effect? Is it effective? What must it never be used alongside and why?

A
  • Combination of ARB and Neprilysin Inhibitor
  • Neprilysin Inhibitor blocks natriuretic peptide breakdown and boosts natriuretic peptide (BNP) levels (opposite effect to RAAS)
  • Will replace ACEIs in moderate to severe heart failure
  • MUST NEVER USE WITH ACEI - both have possibility of angioneurotic oedema
22
Q

What are implantable cardiac defibrillators (ICDs)?

A

Sense rhythm all the time – so if abnormal, patient receives shock to bring rhythm back to normal

23
Q

What is cardiac resynchronisation therapy (CRT) used for? What is this? Explain process of CRT?

A
  • Only used for bundle branch block (prolonged QRS)
  • BBB - right and left ventricle do not contract at exactly the same time so flow of blood through heart is impeded
  • Complicated pacemaker system using 3 different pacemakers to cause RV and LV to contract at same time - CO improves
24
Q

What is Digoxin used for? (2) Why must Digoxin levels be measured in bloodstream regularly?

A
  • Excellent therapy for AF
  • Mediocre therapy for CCF in sinus rhythm
  • Has a very narrow therapeutic window
25
Q

Why is it easy for toxic levels of Digoxin to build up in body? When would reduced doses be required?

A
  • Builds up slowly in body and is excreted slowly by kidneys (1/3rd each day)
  • Patients with renal impairment e.g. elderly
26
Q

Side effects of Digoxin? (3)

A
  • Nausea, vomiting
  • Bradycardia, Heart Block
  • Any arrhythmia e.g. ventricular tachycardia or paroxysmal atrial tachycardia with block
27
Q

What are clinical effects of A-V block by Digoxin? (2)

Clinical effects of irritable ventricles due to Digoxin?

A

Good
* Slows fast AF
Bad
* Bradycardia, heart block

Always bad
* Ventricular arrhythmias

28
Q

What is treatment for ACUTE LVF? (5)

A
  • Sit up (removed fluid from lungs)
  • Oxygen (caution in COPD)
  • Intravenous Furosemide – fast onset (feel better in 20 mins)
  • Intravenous Diamorphine (not in COPD – will stop breathing)
  • Intravenous nitrates

Cardiovascular (28 decks)

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