Heart Failure Flashcards
What is heart failure also referred to as?
Congestive cardiac failure
What is heart failure caused by?
Low cardiac output
What are the types of heart failure?
- LVF
- RVF
- mixed
What are the main causes of LVF?
- interstitial disease especially previous MIs
- cardiomyopathy
- valvular disease
Why do previous MIs cause LVF?
-when have an MI and some of the muscle dies off then that causes scarring which means the ventricle cant contract very well
What causes RVF?
- LVF
- Cor pulmonale
- congenital heart disease
What are the symptoms of LVF?
- dyspnoea on exertion/rest
- orthopnoea
- paroxysmal nocturnal dyspnoea
- pulmonary oedema
What are the signs of LVF?
- tachycardia
- fine crepitation
- pleural effusion
- 3rd heart sound
What do you get if you mix the third heart sound with tachycardia?
galloping
What do you see on a CXR in LVF?
- cardiomegaly
- bats wing shadows on lower zones
- interstitial fluid
What is another cause of pleural effusions?
lung cancer
What are the symptoms of RVF?
oedema
What are the signs of RVF?
- oedema
- elevated JVP
- hepatomegaly
- ascites
What would you see on a CXR in RVF?
normal usually since you dont see the R side on CXR most the time
In which causes for HF is standard medical therapy for HF used?
- Previous Mis
- Cardiomyopathies
What is the specific therapy used for HF caused by cor pulmonale?
-Rx diuretics and oxygen only
What is the specific therapy used for HF caused by valvular disease?
-surgery ideally (valve replacement)
What is the specific therapy used for HF caused by fast AF?
Digoxin or DC shock
What is the most commonly used standard medical treatment for CCF?
- diuretics
- ACEI
- Bblockers
- spironolactone
What can also be considered standard medical treatment for CCF?
- digoxin
- other vasodilators
- implantable cardiac defibrillators
- cardiac resynchronisation therapy
- transplantation
Which diuretic is preferred in CCF?
loop diuretics
What is one of the side effects of furosemide?
lose potassium
How can the loss of potassium be regained?
use of furosemide alongside ACEI and spiralactone which increase K
What is one of the most undesired side effects of spiralactone?
Gynaecomastia - reduces the male hormones in men causing moobs. Reduces female hormones in women as well
What does ivabradine do?
slows HR in sinus rhythm and is useful in people who cant take B Blockers such as asthmatics. Also can be used in angina
What is sacubitruil-valsartan?
combination of ARB and Neprilysin Inhibitor
What does Neprilysin Inhibitors do?
blocks natriuretic peptide breakdown and boosts natriuretic peptide levels
What could sacubitruil-valsartan replace in the future?
ACEIs
What is a side effect of sacubitruil-valsartan
angioneurotic oedema
What must you not use sacubitruil-valsartan alongside?
ACEI, must jeep 48h between use of each
What is the advantage of cardiac resynchronisation therapy?
3 pacemakers inserted to force LV and RV to contract together at same time.
What do normal pacemakers do?
stimulate only the right side of the heart
When do we use cardiac resynchronisation therapy?
in prolonged QRS and bundle branch block
What si the acute LVF therapy?
- sit up
- oxygen (careful in COPD)
- intravenous furosemide
- intravenous diamorphine (not in COPD)
- Intravenous nitrates
