Heart Failure Flashcards
What is Congestive Cardiac Failure due to?
low cardiac output (in most cases)
Why does low cardiac output cause issues?
It causes the kidney to be under perfused so it retains salt and water
Retained salt and water makes breathlessness worse
What are the two types of Heart Failure?
Acute
Chronic
What can cause Left sided HF?
Ischaemic heart disease
MIs
cardiomyopathy
valvular disease
What can cause Right sided HF?
secondary to left side
congenital heart disease
cor pulmonale
What are the symptoms of HF?
Dyspnoea on exertion/rest
Orthopnoea – breathless when lying flat
Paroxysmal nocturnal dyspnoea
Pulmonary oedema (sudden dyspnoea pink, frothy sputum)
What can Orthopnoea also be a sign of?
Asthma
What are Left Ventricular HF clinical signs?
Tachycardia
Fine crepitations – fluid retained in the lungs
Pleural effusion
3rd heart sound (Gallop rhythm = S3 + Tachycardia)
How does Left HF look on a CXR?
Cardiomegaly – to compensate
Bats wing shadows esp. lower zones
Interstitial fluid
What is the symptom of Right HF?
Oedema
What are the signs of Right HF?
Oedema (ankle/sacral)
JVP elevated (>4cm above sternal angle)
Hepatomegaly
Ascites (fluid in abdomen)
What does Right HF look like on a CXR?
Normal
What is the first line standard treatment for CCF?
- Diuretics to excrete retained fluid
- Angiotensin converting enzyme inhibitors
- Beta Blockers (caution required)
- Spironolactone (severe cases only)
What is the second line standard treatment for CCF?
Digoxin Other vasodilators (nitrates, hydralazine)
What is the third line standard treatment for CCF?
Implantable Cardiac Defibrillators
Cardiac Resynchronisation Therapy
Transplantation
When CCF is caused by Cor Pulmonale, what is the treatment?
Diuretics and Oxygen
When CCF is caused by Valvular Disease, what is the treatment?
Surgery
When CCF is caused by Fast AF, what is the treatment?
DC Shock
Digoxin
What are the names of the Diuretics used to treat CCF?
thiazide diuretics - only for mild CCF loop diuretics (furosemide)
What are the names of the ACE Inhibitors used to treat CCF?
Captopril
Enalapril
Lisinopril
What are the side effects of ACE inhibitors?
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
When would you substitute an ACE with an ARB?
When the patient has a cough
What are the names of the Beta Blockers used to treat CCF?
Bisoprolol (β1 selective)
Carvedilol (Non-selective plus alpha blockade)
What are the side effects of Beta Blockers?
Hypotension
Worsening Dysponoea
Which drugs increase potassium levels?
Spironolactone and ACE inhibitors
When is Spironolactone used in CCF?
in moderate to severe cases, along with an ACE inhibitor
What are the side effects of Spirononlactone?
Hyperkalaemiat
Renal Dysfunction
Gynaecomastia – breast growth in men
When would you use Ivabradine in CCF?
When patients hert rate is not slowing, even on BBlockers or if the patient cannot take BBlockers
What is Sacubitril-Valsartan?
Combination of ARB and Neprilysin Inhibitor
- blocks natriuretic peptidebreakdown and boosts natriuretic peptide (BNP) levels
Why must an ACE inhibitor and Sacubitril-Valsartan not be used together?
the same life threatening side effect which is Angioneurotic oedema
What is bundle branch block?
right ventricle and left ventricle don’t contract at the exact same millisecond
When is Digoxin used?
Excellent therapy for AF
Mediocre therapy for CCF in sinus rhythm
What are the side effects of Digoxin?
Nausea, vomiting
Bradycardia, Heart Block (pacemaker needed)
Sudden death as it can produce any arrhythmia
What are the 5 steps of acute Left HF therapy?
- Sit patient up – so gravity shifts fluid away from the lungs
- Oxygen (care in COPD)
- Intravenous Furosemide
- Intravenous Diamorphine (not in COPD)
- Intravenous Nitrates
