Heart failure Flashcards
Diastolic HF is
can’t fill enough - EF preserved
Systolic HF is
can’t pump hard enough
Left sided HF causes
IHD
Hypertension
Dilated cardiomyopathy
Aortic stenosis
Bonus question
What cells do you find in the lungs in heart failure?
Haemosiderin-laden macrophages.
Because capillaries bleed into alveoli under the pressure, and the resident macrophages (AKA dust cells) munch up the RBCs - and go brown from the iron
Right sided HF causes
Left sided HF
Septal defects (Left to right shunts)
Chronic lung disease - Cor pulmonale
Left ventricular failure symptoms 1/2 - resp related
heart failure
Dyspnoea Orthopnoea Paroxysmal nocturnal dyspnoea Noctural cough (pink frothy sputum) Wheeze bibasal crackles
Left ventricular failure symptoms 2/2 - not resp
heart failure
Fatigue Reduced exercise tolerance Nocturia Cold peripheries Weight loss Muscles wasting
Right ventricular failure symptoms
heart failure
Peripheral oedema Ascites Nausea Anorexia Facial engorgement Nosebleed (epistaxis) JVP
Signs of congestive heart failure (Major criteria)
2major or 1major + 2 minor = diagnosis
Paroxysmal nocturnal dyspnoea JVP raised Crepitations S3 gallop Acute pulmonary oedema Hepatojugular reflux Cardiomegaly (displaced apex beat) Increased central venous pressure Weight loss
Signs of congestive heart failure (Minor criteria)
2major or 1major + 2 minor = diagnosis
Bilateral ankle oedema Nocturnal cough Dyspnoea on exertion Hepatomegaly HR > 120 Pleural effusion Vital capacity less than 66.6% normal
Chest X ray signs?
heart failure
ABCDE Alveolar oedema - bat wings Kerley B lines Cardiomegaly Dilated prominent upper lobe vessels Pleural effusion
Tests (heart failure)
BNP
Echocardiography - EF <0.4
CXR
-Bonus, FBC, U&E, ECG
First line treatment (heart failure)
ACEi + B blockers, Spironolactone, start them one at a time
Second line treatment (heart failure)
cardiac resynchronisation therapy if BBB
if drugs ineffective - hydralazine, digoxin (if sedentary)
transplant
Symptomatic treatment (heart failure)
Loop diuretics - furesemide
