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Cardiovascular > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is heart failure and what is the most common type?

A

Congestive cardiac failure
This is a syndrome, not just one disease.
Normally due to a low cardiac output- low output CCF

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2
Q

What are the classifications of heart failure?

A

Left HF, Right HF, Bilateral HF

Acute (LHF) vs chronic

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3
Q

What are the signs and symptoms of heart failure?

A

Caused by fluid retention. When the CO is low, the body retains lots of fluid as the kidney is under purfused => retains Na+ and water

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4
Q

What are the causes of left heart failure?

A

1) Ischemic heart disease and previous MIs
2) Cardiomyopathy
3) Valvular disease eg mitral regurgitation

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5
Q

What are the causes of right heart failure?

A

1) Secondary to left heart failure
2) Cor Pulmonale
3) Congenital heart disease- more often effects right than left heart

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6
Q

What are the symptoms of left heart failure?

A

Dysponea on exertion/rest
Orthopnia- breathless while lying flat
Paroxysmal nocternal dyspnoea
Pulmonary oedema

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7
Q

What would you find on examination of someone with left heart failure?

A

Tachycardia
Fine crepetations at lung bases
Pleural effusions
Third heart sound and gallop rhythm

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8
Q

What would you find on CXR of someone with left heart failure?

A

Cardiomegaly
Bat wing shadows in lower zones
Interstitial fluid => hazy consolidation

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9
Q

What are the symptoms of right heart failure?

A

Oedema- sacrel/ankle

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10
Q

What would you find on examination of someone with left heart failure?

A

Oedema- sacral/ankle
Elevated JVP
Hepatomegaly
Ascites- free fluid in abdomen

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11
Q

What would you find on CXR of someone with left heart failure?

A

Normal as difficult o see right side of heart

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12
Q

How is heart failure due to cor pulmonale treated?

A

Diuretics and oxygen

Treat the lung disease

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13
Q

How is heart failure due to valvular disease treated?

A

Surgery

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14
Q

How is heart failure due to fast atrial fibrilation treated?

A

Digoxin/ beta blockers

Direct current cardioversion DCCV

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15
Q

How is heart failure due to MI, ischemia and cardiomyopathies treated?

A

Standard CCF therapy

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16
Q

What is standard CCF therapy?

A

1) Diuretics
2) ACE inhibitors
3) Beta blockers
4) Aldosterone receptor agonists- spiralactone

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17
Q

How are diuretics used in standard CCF therapy?

A

Thiazide diuretics for mild CCF only- bendroflumethazide
Loop diuretics for mederate-severe CCF Furusamide
Cause a loss of Na+ and water (good) but also loss of K+ (bad) ACEi and Spiralactone help to retain K+

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18
Q

Why are ACE inhibitors used in standard CCF therapy?

A

Inhibit angiotensin 2 formation => vasodilation and inhibit the breakdown of bradykinin => vasodilation

19
Q

What are the initial risks of using beta blocker in standard CCF therapy?

A

Can worsen CCF in the short term but increase life expectancy and QoL in the long term. Start low and go slow.
Initial risks = hypotention and worsening dyspnoea

20
Q

How do beta blockers work in CCF therapy?

A

Block beta 1 receptors on cardiac myocytes => negative ionotrophic and chronotrophic effects

21
Q

Give some examples of beta blockers used in CCF therapy?

A

Bisoprolol and atenalol- cardioselective
Propranolol- non selective
Carvedarol- non selective and alpha receptor blockade

22
Q

Give some examples of ACE inhibitors used in CCF?

A

Catopril, Enalapril, Lisinopril

23
Q

What are the side effects of ACE inhibators?

A

Side effects = angioneurotic oedema, first dose hypotention, renal impairment (monitor U+Es), dry cough

24
Q

Why is spiralactone used in moderate to severe CCF?

A

Aldosterone receptor antagonist- causes vasodilation and Na+ and water to be lost from the kidneys

25
Q

What are the side effects of spiralactone?

A

Hyperkalemia, renal dysfunction and gynaecomastia

26
Q

Ivabradine is a newer agent used in CCF. How does it work?

A

Only works when the heart is in sinus rhythm

Inhibition of the funny current channel so decreases the heart rate

27
Q

When is Ivabradine used in CCF?

A

Only if the heart rate is still fast despite beta blockers or if beta blockers cannot be tolerated (severe asthma)

28
Q

Wht is the target HR for someone with CCF?

A

60-70bpm

29
Q

Sacubitril-Valsartan is a new drug used in CCF. How does it work?

A

Combines ARB with Neprilysin inhibitor which blocks natiuretic peptide breakdown, boosing BNP levels => vasodilation.

30
Q

What other drug must you not combine with Sacubitril-Valsartan?

A

ACE inhibator

31
Q

What are the two main effects of digoxin?

A

1) Blocks conduction between the artia and the ventricles

2) Ventricular irritation => arrhythmias (toxic concentrations)

32
Q

Why is digoxin difficult to use?

A

Narrow therapeutic index- measure digoxin levels in the blood
Excreated slowly by the kindney- elderly with renal impairment need reduced dose

33
Q

What are the side effects of digoxin?

A

Nausea, vomminting, bradycardia, heart block and other arrythmias

34
Q

When is digoxin used?

A

AF and sometimes CCF

35
Q

Can other vasodilators such as nitrates and hydralazine be used to treat CCF?

A

Yes

36
Q

When are implantable cardiac defibrilators used?

A

Commonly in arrythmias and in selective patients with CCF

37
Q

When is cardiac resynchronisation therapy used?

A

Patients with a prolonged QRS complex which implies bundle branch block. The right and left ventricle do not contract together- inefficient

38
Q

What is cardiac resynchronisation therapy (CRT)?

A

3 pacemaker leads rather than 2 to stimulate both the right and left side of the heart so they contract together

39
Q

When would a heart transplant be considered in CCF?

A

Young fit people. Last resort

40
Q

What are the 5 steps for treating acute left ventricular failure?

A

1) Sit patient up
2) Give oxygen if hypoxic
3) IV furusumide
4) IV diamorphine (aviod in COPD)
5) IV organic nitrates

41
Q

Which gene is associated with atherosclerosis?

A

Chromosome 9P21

42
Q

What causes systolic heart failure?

A

A weak heart

43
Q

What causes diastolic heart failure?

A

A stiff heart

44
Q

Is an elevated BNP a sign of heart failure?

A

Can be. Has a better negative predictive value so if you don’t have a raised BNP, unlikely to be heart failure but a raised BNP can be due to other things

Cardiovascular (24 decks)

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