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1. Cardiovascular > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is Congestive Cardiac Failure due to?

A

low cardiac output (in most cases)

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2
Q

Why does low cardiac output cause issues?

A

It causes the kidney to be under perfused so it retains salt and water
Retained salt and water makes breathlessness worse

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3
Q

What are the two types of Heart Failure?

A

Acute

Chronic

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4
Q

What can cause Left sided HF?

A

Ischaemic heart disease
MIs
cardiomyopathy
valvular disease

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5
Q

What can cause Right sided HF?

A

secondary to left side
congenital heart disease
cor pulmonale

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6
Q

What are the symptoms of HF?

A

Dyspnoea on exertion/rest
Orthopnoea – breathless when lying flat
Paroxysmal nocturnal dyspnoea
Pulmonary oedema (sudden dyspnoea pink, frothy sputum)

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7
Q

What can Orthopnoea also be a sign of?

A

Asthma

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8
Q

What are Left Ventricular HF clinical signs?

A

Tachycardia
Fine crepitations – fluid retained in the lungs
Pleural effusion
3rd heart sound (Gallop rhythm = S3 + Tachycardia)

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9
Q

How does Left HF look on a CXR?

A

Cardiomegaly – to compensate
Bats wing shadows esp. lower zones
Interstitial fluid

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10
Q

What is the symptom of Right HF?

A

Oedema

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11
Q

What are the signs of Right HF?

A

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

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12
Q

What does Right HF look like on a CXR?

A

Normal

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13
Q

What is the first line standard treatment for CCF?

A
  • Diuretics to excrete retained fluid
  • Angiotensin converting enzyme inhibitors
  • Beta Blockers (caution required)
  • Spironolactone (severe cases only)
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14
Q

What is the second line standard treatment for CCF?

A 
Digoxin
Other vasodilators (nitrates, hydralazine)
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15
Q

What is the third line standard treatment for CCF?

A

Implantable Cardiac Defibrillators
Cardiac Resynchronisation Therapy
Transplantation

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16
Q

When CCF is caused by Cor Pulmonale, what is the treatment?

A

Diuretics and Oxygen

17
Q

When CCF is caused by Valvular Disease, what is the treatment?

A

Surgery

18
Q

When CCF is caused by Fast AF, what is the treatment?

A

DC Shock

Digoxin

19
Q

What are the names of the Diuretics used to treat CCF?

A 
thiazide diuretics - only for mild CCF
loop diuretics (furosemide)
20
Q

What are the names of the ACE Inhibitors used to treat CCF?

A

Captopril
Enalapril
Lisinopril

21
Q

What are the side effects of ACE inhibitors?

A

Angioneurotic oedema (Life threatening but rare)
First dose causes hypotension esp. if serum Na low
Renal Impairment – UE must be monitored after AECI begun
Cough

22
Q

When would you substitute an ACE with an ARB?

A

When the patient has a cough

23
Q

What are the names of the Beta Blockers used to treat CCF?

A

Bisoprolol (β1 selective)

Carvedilol (Non-selective plus alpha blockade)

24
Q

What are the side effects of Beta Blockers?

A

Hypotension

Worsening Dysponoea

25
Q

Which drugs increase potassium levels?

A

Spironolactone and ACE inhibitors

26
Q

When is Spironolactone used in CCF?

A

in moderate to severe cases, along with an ACE inhibitor

27
Q

What are the side effects of Spirononlactone?

A

Hyperkalaemiat
Renal Dysfunction
Gynaecomastia – breast growth in men

28
Q

When would you use Ivabradine in CCF?

A

When patients hert rate is not slowing, even on BBlockers or if the patient cannot take BBlockers

29
Q

What is Sacubitril-Valsartan?

A

Combination of ARB and Neprilysin Inhibitor

- blocks natriuretic peptidebreakdown and boosts natriuretic peptide (BNP) levels

30
Q

Why must an ACE inhibitor and Sacubitril-Valsartan not be used together?

A

the same life threatening side effect which is Angioneurotic oedema

31
Q

What is bundle branch block?

A

right ventricle and left ventricle don’t contract at the exact same millisecond

32
Q

When is Digoxin used?

A

Excellent therapy for AF

Mediocre therapy for CCF in sinus rhythm

33
Q

What are the side effects of Digoxin?

A

Nausea, vomiting
Bradycardia, Heart Block (pacemaker needed)
Sudden death as it can produce any arrhythmia

34
Q

What are the 5 steps of acute Left HF therapy?

A
  1. Sit patient up – so gravity shifts fluid away from the lungs
  2. Oxygen (care in COPD)
  3. Intravenous Furosemide
  4. Intravenous Diamorphine (not in COPD)
  5. Intravenous Nitrates

1. Cardiovascular (30 decks)

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