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Cardiovascular System > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is congestive heart failure?

A

When the heart is unable to pump blood at a rate that meets the requirements of the tissue or can do so only from high pressures

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2
Q

What are underlying structural abnormalities which can cause heart failure?

A 
LV systolic dysfunction 
Valvular heart disease 
Pericardial constriction or effusion
LV diastolic dysfunction/HF with sys function or normal EF 
Tachycardia or bradycardia 
MI
Restrictive cardiomyopathy (amyloid, hypertrophic CM)
RV failure: primary or secondary PHT
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3
Q

What are the causes of LVSD?

A 
Ischaemic heart disease (MI)
Severe AV disease or MR 
Dilated cardiomyopathy 
Hypertension
HIV, lyme's disease
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4
Q

What are the symptoms of congestive heart failure?

A

Dyspnoea
Fatigue
Oedema
Reduced exercise capacity

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5
Q

What are the signs of CHF?

A 
Oedema 
Tachycardia 
Raised JVP 
Chest crepitation or effusion
3rd heart sound
Displaced apex beat
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6
Q

Why carry out an CXR?

A 
Signs of:
Pul. oedema 
Cardiomegaly 
Effusion 
Sternal wires (previous op)
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7
Q

What bloods should be carried out?

A 
FBC
Fasting glucose 
U+Es 
Urinalysis 
TFT
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8
Q

What investigations should be carried out?

A 
CXR
Bloods
Echo
Radionucleotide scan 
L ventriculogram (angiogram)
CMRI 
ECG (HF unlikely is normal)
BNP level - Amino acid peptide elevated in HF 
Response to therapy (diuretics) 
MUGA scan for LVEF
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9
Q

What tests are used to show evidence of cardiac dysfunction?

A

Echo
Radionecleotide scan
L ventriculogram (angiogram)
CMRI

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10
Q

Name types of diuretic drugs

A

Furosemide and bumetanide

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11
Q

Name types of ACEi drugs

A

Ramipril, enalpril snd lisinopril

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12
Q

What are the ranges of LV ejection fraction?

A 
Effected by disease - anaemia, sepsis etc 
Normal: 50-80%
Mild: 40-50%
Moderate: 30-40%
Severe: <30%
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13
Q

How does heart failure affect cardiac output?

A

HF does not mean reduced CO - EF might lower but might be tachcardic to compensate

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14
Q

Is heart failure the final diagnosis?

A

No, there is underlying structural abnormality and cause:
HF due to LVSD due to IHD
HF due to severe aortic stenosis

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15
Q

What percentage of people in the UK suffer from HF?

A

1-2%

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16
Q

What is the prognosis in the first year of developing HF?

A

Poor: 30-40% mortality

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17
Q

How many inpatient bed days are caused by HF and what is the readmission rate over the nest 3 months?

A

1 million inpatient bed days

50% readmitted

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18
Q

What are the factors that are contributing to the increase in prevalence of heart failure?

A

Treatment of acute myocardial infarction - prev MI increases risk of CHF
Ageing population
Increased prevalence of: hypertension, CHD, obesity, diabetes, high cholesterol

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19
Q

What does displaced apex beat indicate?

A

Enlargement of the heart

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20
Q

What is the 2/3 criteria for heart failure to be diagnosed?

A
  1. Symptoms or signs of HF (rest or exercise)
    and
  2. Objective evidence of cardiac dysfunction
    and (in doubtful cases)
  3. Response to therapy (diuretics)
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21
Q

What are the 2 investigations that can be carried out for screening for congestive heart failure?

A

ECG - if normal then rules out LVSD

Brain natriuretic peptide - the amino acid is elevated in HF, low BNP excludes HF

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22
Q

What does raised brain natiuretic peptide indicate?

A

Heart failure or left ventricular systolic dysfunction, and indicates the need for echo/cardiac assessment

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23
Q

What is the order of investigations and examination for the diagnosis of HF?

A
  1. Symptoms of signs suggest CHF
  2. FBC, fasting blood glucose, U+Es, urinalysis, TFT and CXR
  3. BNP and ECG
  4. If BNP elevated or ECG abnormal
  5. Refer for echocardiography
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24
Q

What is way to diagnose LVSD?

A
  1. Clinical history: MI, DM, HBP, post partum, alcohol
  2. ECG, CXR, and always an echo
  3. Coronary angigraphy (if chest pain, <70)
  4. Cardiac MRI: infarction/inflammation/fibrosis
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25
Q

What is an echo an essential investigation for HF?

A 
Shows:
LVSD
Valvular dysfunction 
Pericardial effusion / tamponade 
Diastolic dysfunction 
LVH
Atrial/ventricular shunts / congenital heart defects
PHT/ R heart dysfunction
26
Q

What are the investigations done to assess LVEF?

A

MUGA and MRI

27
Q

What are the pros and cons of MUGA in measuring LVEF over echo?

A

Easier to obtain accurate figure
Greater reproducibility

But
Ionising radiation
No additional structural info

28
Q

What are the pros of using MRI to measure LVEF?

A

Greater reproducibility
Added into about:
Aetiology - fibrosis, infiltration, oedema
Valves

29
Q

What are the cons of using MRI to measure LVEF?

A

Time consuming
Patient compliance - long breath holds, claustrophobic, ability to lie flat
Specialist centres
Long waiting lists

30
Q

What classification if used to grade heart failure?

A

New York Association (NYHA)

31
Q

Describe classifications of heart failure using the NYHA

A

I - no symptoms on usually activity
II - comfortable with rest or mild exertion
III - comfortable only at rest
IV - discomfort of physical activity

32
Q

What symptoms are used to characterised chronic heart failure?

A 
Progressive cardiac dysfunction 
SOB 
Fatigue 
Neurohormonal disturbances 
Sudden death
33
Q

What is systolic heart failure?

A

Decreased pumping function of the heart, which results in fluid back up in the lung and heart failure

34
Q

What is diastolic heart failure?

A

Thickening and stiffening of the heart muscle causing the heart to not fill up with blood properly, which causes fluid back up in the lungs and heart

Normal EF but not as much blood in the ventricle in the first place

35
Q

What are the risk factors for HF?

A 
CAD
HPT 
Valvular disease 
Alcoholism 
Infection (viral)
DIabetes 
Congenital heart defects 
Other: age, smoking, obesity, obstructive sleep apnoea
36
Q

How can the risk factors lead to heart failure in general terms?

A
  1. Cause myocardial injury
  2. Pathologic remodelling
  3. Low ejection fraction
  4. Death or pump failure -> heart failure
37
Q

Describe the pathophysiology of systolic dysfunction heart failure?

A
  1. Failing or damaged heart causes it to not follow Starling’s law
  2. So cardiac output decreases
  3. This activates RAAS and sympathetic system and circulatory volume increases and vasoconstriction
  4. This causes further dilation, CO drops further as the myocytes undergo hypertrophy and then fibrose causing further tweaking
38
Q

What 2 drugs are given to improve symptoms?

A

Diuretics

Digoxin

39
Q

What 3 drugs are give to improve symptoms and survival?

A

ACEi/ARBs
Spironolactone
Valsartan-sacubitril (ARNI)

40
Q

What 2 drugs are given to improve survival?

A

Beta blockers

Ivabridine

41
Q

What are the diuretics used for the treatment of symtpoms of heart failure?

A

Furosemide or Bumetanide

42
Q

Which Beta Blockers are used to block detrimental hormonal changes (adrenaline) in heart failure?

A

Carvedilol
Bisoprolol
Metoprolol

43
Q

Which 2 groups of drugs are available for the blocking of angiotensin II effects in heart failure? and give examples

A

ACE inhibitors - ramipril

ARBS - valsartan, losartan

44
Q

What drug blocks the effects of aldosterone in heart failure?

A

Spironolactone

45
Q

What is the action of the drug Neprolysin?

A

Prevents metabolism of ANP/BNP and enhances their actions

46
Q

What do positive inotropes do and what is their action?

A

Improve ability of heart to pump by increasing availability of Ca in the myocyte - Digoxin

47
Q

How are vasodilators useful in cardiac failure and give an example?

A

Reduces preload and after load - isosorbide mono or dinitrate

48
Q

What is the action of loop diuretics (furosemide) in improving symptoms?

A

Removes excess salt and water by inducing diuresis (urine output) and block the Na-K-Cl transporter in the Loop of Henle, preventing reabsorption of sodium and water

49
Q

What are the adverese drug reactions of furozemide?

A 
Dehydration 
Hypotension 
Hypokalaemia, hypronatraemia 
Gout
Imparied glucose tolerance, diabetes
50
Q

What drugs do furosemide interact with?

A 
Aminoglycosides 
Lithium 
NSAIDs
Antihypertensives 
Vancomycin
51
Q

What general actions of different drugs will reduce mortality in heart failure?

A

Angiotensin blockade
Beta receptor blockade
Aldersterone blockade
ANP/BNP enhancement

52
Q

What is the effect of ACE inhibitors?

A

Block angiotensin converting enzyme, preventing conversion of angiotensin I to II
Reduces preload and afterload of the heart (by prevent vasoconstriction)

53
Q

What are the adverse effects of ACEis?

A 
First dose hypotension 
Cough 
Angioedema 
Renal impairment 
Renal failure 
Hyperkalaemia
54
Q

What drugs do ACEis interact with?

A

NSAIDs
Potassium supplements
Potasium sparing diuretics

55
Q

What is the action of ARBs?

A 
Block angiotensin II receptor AT1 receptor
Inhibits: 
Vasoconstriction 
Hypertrophy
Increased sympathetic tone
56
Q

What is the action of aldersterone antagonists and give example?

A

Potassium sparing diuretic which inhibits the actions of aldosterone by acting in the distal tube - spironolactone

57
Q

What is the action of ivabridine?

A

Inhibits the If current in the SA node - slows depolarisation and thus heart rate

58
Q

Why can anti-coagulants be useful in heart failure?

A

Dilated ventricle gives rise to thrombus formation and thromboembolic events - warfarin

59
Q

Outline the therapeutic regime for heart failure

A 
Furosemide 
ACEi
ARB
Sacubitril and valsartan (ARNI)
B block +/- ivabridine 
Spironolactone 
Digoxin 
Warfarin
60
Q

What are ways that are used to monitor benefit of drugs?

A

Symptomatic relief - SOB, fatigue
Clinical relief - Peripheral. oedema, ascites
Monitor weight (shows water retention)

Cardiovascular System (37 decks)

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