Heart Failure Flashcards
what is heart failure
(a.k.a congestive cardiac failure)
syndrome not one disease, due to low cardiac output in most cases
what are the different types of heart failure
left, right and mixed
acute and chronic
what causes the sign and symptoms of heart failure
fluid retention
why does cardiac output cause fluid retention
when kidney is under perfused it retains salt and water
what is left sided heart failure mainly due to
ischaemic heart disease, myocardial infarction, cardiomyopathy, valvular disease
what is right sided heart failure mainly due to
secondary to left sided heart failure, cor pulmonale, congenital heart disease
how does a myocardial infarction cause congestive cardiac failure
scar tissue replacing replacing healthy tissue doesn’t contract properly, reducing CO
how does valvular disease cause congestive cardiac failure
valves not working properly, leaks so blood flows backwards/ forward reducing CO
what is Cor pulmonale
when any lung disease puts a strain on the right side of the heart and it fails
what are the symptoms of left ventricular failure
dyspnoea on exertion/rest,
orthopnoea,
paraoxysmal nocturnal dyspnoea,
pulmonary oedema (sudden dyspnoea and pink frothy sputum)
describe orthopnoea in left ventricular failure
because of gravity, fluid in lungs shifts when lying down making shortness of breath worst
describe paroxysmal nocturnal dyspnoea
patient wakes up breathless, rushes to window then feels better- can also be asthma in which breathlessness is worse at night
what are the clinical signs of left ventricular failure
tachycardia, fine crepitations, pleural effusion, third heart sound (gallop rhythm = S3 + tachycardia)
what can be seen on a CXR of someone with left ventricular failure
cardiomegaly, bats wing shadow esp. lower zones, interstitial fluid
why is tachycardia associated with left ventricular failure
heart compensating for low CO
what causes the crepitaitions in LVF
fluid accumulating in the lung bases
what causes the pleural effusion in LVF
extra fluid in pleural cavity
what causes the cardiomegaly
heart bigger to compensate for low CO
what are the symptoms of right heart failure
oedema
what are the clinical signs of right heart failure
oedema (ankle/sacral),
JVP elevated (>4cm above sternal angle),
hepatomegaly (abnormal enlargement of the liver),
ascites (fluid in the abdomen)
what is seen in a CXR of someone with right side heart failure
normal
in right side heart failure where does fluid collect
in VC, abdomen, ankles, stomach, neck, JVP
how is heart failure caused by cor pulmonale treated
diuretics and oxygen only
how is heart failure caused by valvular disease treated
surgery ideally
how is heart failure caused by fast atrial fibrillation treated
digoxin or DC shock
how does fast AF cause heart failure
ventricle beating too quickly doesn’t have time to refill
how is heart failure caused by fast AF treated
digoxin or DC shock (direct current- defibrillation)
what causes of congestive cardiac failure are treates with the standard medical treatment of CCF
previous MIs and cardiomyopathies
what is the standard medical treatment for CCF
diuretics to excrete retained fluid,
angiotensin converting enzyme inhibitors,
beta blockers,
spironolactone (severe cases only)
digoxin and other vasodilators (nitrates, hydralazine)
implantable cardiac defibrillators,
cardiac resynchronisation therapy,
transplantation
what does a diuretic do
causes an increase in urine
what type of diuretics are used in CCF
loop diuretics and thiazide diuretics (for mild CCF only as less effective)
give an example of a loop diuretic used in CCF
furosemide
why are ace inhibitors and spironolactone benficial when using a diuretic to treat CCF
as diuretics can cause decrease in potassium in blood and these drugs can help retain and normalise K
how do ACE inhibitors work
prevents angiotensin II being formed from angiotensin
what do all ace inhibitors end in (give three examples)
pril: captopril, enalapril and lisinopril
what are the side effects of ACE inhibitors
angioneurotic oedema (allergic response where skin and larynx swell up- rare but life threatening), first dose hypotension, renal impairment, dry cough (use angiotensin receptor blocker instead (losartan)
how do angiotensin II receptor blockers work
stop angiotensin II binding to its receptor
what do all angiotensin II receptor blockers end in (give 2 examples)
ARTAN: losartan and valsartan
why must beta blockers be used with caution in CCF
as can worsen in short term- start low dose, increase slowly
what are the initial risks of beta blockers in beta blockers
hypotension and worsening dysponoea
what do beta blockers end in and give examples of two used in CCF
bisoprolol (B1 selective) and carvedilol (non selective)
what is spironolactone
aldosterone receptor antagonist
what does aldosterone do
causes water to be re absorbed
in what severity of CCF should spironolactone be used
moderate/ severe
what are the side effects of sprionolactone
hyperkalaemia (increased potassium), renal dysfunction, gynaecomastia (breast growth by disruption of male sex hormones)
what is ivabradine and when is it used in CCF
slows heart rate, only used when heart failure is not fully managed with beta blockers
what is sacubitril-valsartan
combination of ARB (valsartan) and neprilysin inhibitor (sacubitril)
what does a neprilysin inhibitor do
blocks natriuretic peptide breakdown and boosts natriuretic peptide (BNP) levels
what does sacubitril- valsartan do in heart failure and in what severity of CCF should it be used
replaces ACE inhibitors in severe heart failure
MUST NOT BE USED ALONG WITH AN ACE INHIBITOR
What does cardiac resynchronisation therapy do and in what type of CCF
to make right and left sides contract at the same time- only for prolonged QRS- 3 pacemakers inserted to force LV and RV to contract together
what causes the left and right ventricles to contract at different times
bundle branch block- long QRS
why does digoxin have narrow therapeutic threshold
as excreted slowly by kidneys- 1/3 each day, builds up
what is digoxin used in and its efficiency in both
excellent therapy for AF
mediocre therapy for CCF IN SINUS RHYTHM ONLY
what are the side effects of digoxin
nausea, vomiting, bradycardia, heart block (atria and ventricles contracting independently), arrhythmia
how does digoxin work
AV block
what are the acute therapies of acute LVF therapy
sit up- gets fluid away from the lungs
oxygen
intravenous furosemide (lasix) (loop diuretics)
intravenous diamorphine (not in COPD)
(intravenous nitrates can be used in angina)
