Heart Failure Flashcards by Anna Marshall

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

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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What are the classifications of heart failure?

Left HF, Right HF, Bilateral HF

Acute (LHF) vs chronic

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What are the signs and symptoms of heart failure?

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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What are the causes of left heart failure?

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

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What are the causes of right heart failure?

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

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What are the symptoms of left heart failure?

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

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

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

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

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

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What are the symptoms of right heart failure?

Oedema- sacrel/ankle

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

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

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

Normal as difficult o see right side of heart

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How is heart failure due to cor pulmonale treated?

Diuretics and oxygen

Treat the lung disease

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How is heart failure due to valvular disease treated?

Surgery

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How is heart failure due to fast atrial fibrilation treated?

Digoxin/ beta blockers

Direct current cardioversion DCCV

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

Standard CCF therapy

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What is standard CCF therapy?

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

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How are diuretics used in standard CCF therapy?

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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Why are ACE inhibitors used in standard CCF therapy?

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

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

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

How do beta blockers work in CCF therapy?

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

Give some examples of beta blockers used in CCF therapy?

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

Give some examples of ACE inhibitors used in CCF?

Catopril, Enalapril, Lisinopril

What are the side effects of ACE inhibators?

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

Why is spiralactone used in moderate to severe CCF?

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

What are the side effects of spiralactone?

Hyperkalemia, renal dysfunction and gynaecomastia

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

Only works when the heart is in sinus rhythm | Inhibition of the funny current channel so decreases the heart rate

When is Ivabradine used in CCF?

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

Wht is the target HR for someone with CCF?

60-70bpm

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

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

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

ACE inhibator

What are the two main effects of digoxin?

1) Blocks conduction between the artia and the ventricles | 2) Ventricular irritation => arrhythmias (toxic concentrations)

Why is digoxin difficult to use?

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

What are the side effects of digoxin?

Nausea, vomminting, bradycardia, heart block and other arrythmias

When is digoxin used?

AF and sometimes CCF

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

Yes

When are implantable cardiac defibrilators used?

Commonly in arrythmias and in selective patients with CCF

When is cardiac resynchronisation therapy used?

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

What is cardiac resynchronisation therapy (CRT)?

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

When would a heart transplant be considered in CCF?

Young fit people. Last resort

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

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

Which gene is associated with atherosclerosis?

Chromosome 9P21

What causes systolic heart failure?

A weak heart

What causes diastolic heart failure?

A stiff heart

Is an elevated BNP a sign of heart failure?

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