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Cardiovascular > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

what is heart failure

A

(a.k.a congestive cardiac failure)

syndrome not one disease, due to low cardiac output in most cases

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2
Q

what are the different types of heart failure

A

left, right and mixed

acute and chronic

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3
Q

what causes the sign and symptoms of heart failure

A

fluid retention

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4
Q

why does cardiac output cause fluid retention

A

when kidney is under perfused it retains salt and water

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5
Q

what is left sided heart failure mainly due to

A

ischaemic heart disease, myocardial infarction, cardiomyopathy, valvular disease

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6
Q

what is right sided heart failure mainly due to

A

secondary to left sided heart failure, cor pulmonale, congenital heart disease

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7
Q

how does a myocardial infarction cause congestive cardiac failure

A

scar tissue replacing replacing healthy tissue doesn’t contract properly, reducing CO

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8
Q

how does valvular disease cause congestive cardiac failure

A

valves not working properly, leaks so blood flows backwards/ forward reducing CO

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9
Q

what is Cor pulmonale

A

when any lung disease puts a strain on the right side of the heart and it fails

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10
Q

what are the symptoms of left ventricular failure

A

dyspnoea on exertion/rest,
orthopnoea,
paraoxysmal nocturnal dyspnoea,
pulmonary oedema (sudden dyspnoea and pink frothy sputum)

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11
Q

describe orthopnoea in left ventricular failure

A

because of gravity, fluid in lungs shifts when lying down making shortness of breath worst

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12
Q

describe paroxysmal nocturnal dyspnoea

A

patient wakes up breathless, rushes to window then feels better- can also be asthma in which breathlessness is worse at night

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13
Q

what are the clinical signs of left ventricular failure

A

tachycardia, fine crepitations, pleural effusion, third heart sound (gallop rhythm = S3 + tachycardia)

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14
Q

what can be seen on a CXR of someone with left ventricular failure

A

cardiomegaly, bats wing shadow esp. lower zones, interstitial fluid

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15
Q

why is tachycardia associated with left ventricular failure

A

heart compensating for low CO

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16
Q

what causes the crepitaitions in LVF

A

fluid accumulating in the lung bases

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17
Q

what causes the pleural effusion in LVF

A

extra fluid in pleural cavity

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18
Q

what causes the cardiomegaly

A

heart bigger to compensate for low CO

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19
Q

what are the symptoms of right heart failure

A

oedema

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20
Q

what are the clinical signs of right heart failure

A

oedema (ankle/sacral),
JVP elevated (>4cm above sternal angle),
hepatomegaly (abnormal enlargement of the liver),
ascites (fluid in the abdomen)

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21
Q

what is seen in a CXR of someone with right side heart failure

A

normal

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22
Q

in right side heart failure where does fluid collect

A

in VC, abdomen, ankles, stomach, neck, JVP

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23
Q

how is heart failure caused by cor pulmonale treated

A

diuretics and oxygen only

24
Q

how is heart failure caused by valvular disease treated

A

surgery ideally

25
Q

how is heart failure caused by fast atrial fibrillation treated

A

digoxin or DC shock

26
Q

how does fast AF cause heart failure

A

ventricle beating too quickly doesn’t have time to refill

27
Q

how is heart failure caused by fast AF treated

A

digoxin or DC shock (direct current- defibrillation)

28
Q

what causes of congestive cardiac failure are treates with the standard medical treatment of CCF

A

previous MIs and cardiomyopathies

29
Q

what is the standard medical treatment for CCF

A

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

30
Q

what does a diuretic do

A

causes an increase in urine

31
Q

what type of diuretics are used in CCF

A

loop diuretics and thiazide diuretics (for mild CCF only as less effective)

32
Q

give an example of a loop diuretic used in CCF

A

furosemide

33
Q

why are ace inhibitors and spironolactone benficial when using a diuretic to treat CCF

A

as diuretics can cause decrease in potassium in blood and these drugs can help retain and normalise K

34
Q

how do ACE inhibitors work

A

prevents angiotensin II being formed from angiotensin

35
Q

what do all ace inhibitors end in (give three examples)

A

pril: captopril, enalapril and lisinopril

36
Q

what are the side effects of ACE inhibitors

A 
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)
37
Q

how do angiotensin II receptor blockers work

A

stop angiotensin II binding to its receptor

38
Q

what do all angiotensin II receptor blockers end in (give 2 examples)

A

ARTAN: losartan and valsartan

39
Q

why must beta blockers be used with caution in CCF

A

as can worsen in short term- start low dose, increase slowly

40
Q

what are the initial risks of beta blockers in beta blockers

A

hypotension and worsening dysponoea

41
Q

what do beta blockers end in and give examples of two used in CCF

A

bisoprolol (B1 selective) and carvedilol (non selective)

42
Q

what is spironolactone

A

aldosterone receptor antagonist

43
Q

what does aldosterone do

A

causes water to be re absorbed

44
Q

in what severity of CCF should spironolactone be used

A

moderate/ severe

45
Q

what are the side effects of sprionolactone

A

hyperkalaemia (increased potassium), renal dysfunction, gynaecomastia (breast growth by disruption of male sex hormones)

46
Q

what is ivabradine and when is it used in CCF

A

slows heart rate, only used when heart failure is not fully managed with beta blockers

47
Q

what is sacubitril-valsartan

A

combination of ARB (valsartan) and neprilysin inhibitor (sacubitril)

48
Q

what does a neprilysin inhibitor do

A

blocks natriuretic peptide breakdown and boosts natriuretic peptide (BNP) levels

49
Q

what does sacubitril- valsartan do in heart failure and in what severity of CCF should it be used

A

replaces ACE inhibitors in severe heart failure

MUST NOT BE USED ALONG WITH AN ACE INHIBITOR

50
Q

What does cardiac resynchronisation therapy do and in what type of CCF

A

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

51
Q

what causes the left and right ventricles to contract at different times

A

bundle branch block- long QRS

52
Q

why does digoxin have narrow therapeutic threshold

A

as excreted slowly by kidneys- 1/3 each day, builds up

53
Q

what is digoxin used in and its efficiency in both

A

excellent therapy for AF

mediocre therapy for CCF IN SINUS RHYTHM ONLY

54
Q

what are the side effects of digoxin

A

nausea, vomiting, bradycardia, heart block (atria and ventricles contracting independently), arrhythmia

55
Q

how does digoxin work

A

AV block

56
Q

what are the acute therapies of acute LVF therapy

A

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)

Cardiovascular (34 decks)

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