Heart Failure Flashcards
Why do people retain fluid in congestive cardiac failure (CCF)?
Kidney is underperfused so retains salt and water.
What are the signs and symptoms of cardiac failure mainly due to?
Fluid retention.
What are the causes of left heart failure?
Ischaemic heart disease, previous MIs, cardiomyopathy, valvular disease.
What are the causes of right heart failure?
Secondary to left heart failure, cor pulmonale (any severe lung disease puts a strain on right side of heart), congenital heart disease.
What are the symptoms of left heart failure?
Dyspnoea on exertion/rest, orthopnoea, paroxysmal nocturnal dyspnoea (people often run to open a window), pulmonary oedema.
What are the signs of left heart failure?
Tachycardia, fine crepitations, pleural effusion, 3rd heart sound (caused by sudden deceleration of blood entering left ventricle), gallop rhythm (3rd heart sound and tachycardia).
What will you see on a CXR for left heart failure?
Cardiomegaly, bats wing shadows esp lower zones, interstitial fluid.
What are the signs, symptoms and CXR findings of right heart failure?
Symptoms: peripheral oedema.
Signs: peripheral oedema, elevated JVP, hepatomegaly, ascites (fluid in abdomen).
CXR: normal.
What treatment would you give for previous MIs/cardiomyopathies, cor pulmonale, valvular disease and fast AF?
MIs/cardiomyopathies: standard treatment. Cor pulmonale: diuretics and oxygen only. Valvular disease: surgery ideally. Fast AF: digoxin or DC shock.
What is the first line treatment for CCF?
Diuretics, ACIEs, beta blockers (start low go slow), spironolactone (severe cases only).
What is the second line treatment for CCF?
Digoxin (positive inotrope and antiarrhythmic). Other vasodilators (nitrates, hydralazine).
What is the 3rd line treatment for CCF?
Implantable cardiac defib, cardiac resynchronisation therapy, tranplantation.
What type of diuretic is commoner in heart failure?
Loop diuretics e.g. furosemide.
What is a side effect of diuretics but why is this not a big problem in heart failure?
Can lose potassium, coincidental drugs (ACEIs, spironolactone) help retain and normalise K.
Give 3 examples of ACEIs.
Captopril, enalapril, lisinopril.
What are the side effects of ACEIs?
Angioneurotic oedema, first dose hypertension esp if serum Na is low, renal impairment (U/Es must be monitored after ACEI begun).
What are the initial risks of beta-blockers?
Hypotension, worsening dyspnoea.
Give 2 examples of beta blockers.
Bisoprolol (beta1 selective). Carvedilol (non-selective plus alpha blocker).
What class of drug is spironolactone?
Aldosterone receptor antagonist.
When is spironolactone used?
In moderate/severe CCF.
What are the side effects of spironolactone?
Hyperkalaemia, renal dysfunction, gynaecomastia (anti-male sex hormone activity can cause breast growth in men.
What does ivabradine do and when should you use it?
Slows heart rate, only use if HR fast despite beta blockers.
What is the name of the drug that is a combination of an ARB and Neprilysin inhibitor?
Sacubitril-valsartan.
What do neprilysin inhibitors do?
Block natriuretic peptide breakdown and boosts natriuretic peptide (BNP) levels.
