Heart Failure Flashcards
What is left CCF mainly due to?
IHD (MIs)
Cardiomyopathy
Valvular disease
What is right CCF mainly due to?
secondary to LHF
cor pulmonale
congenital heart disease
Symptoms of LVF?
dyspnoea (exertion/rest)
orthopnoea
paroxysmal nocturnal dyspnoea
pulmonary oedema
Signs of LVF?
displaced apex pan systolic murmur tachycardia fine crepitations pleural effusion S3
What might a CXR of LVF show?
cardiomegaly
bats wing shadows esp. lower zones
interstitial fluid
What are signs of pulmonary embolism?
sunken dyspnoea
pink, frothy sputum
What murmur is assoc. with LVF?
pan systolic = functional mitral regurgitation
What heart sound is assoc. with LVF?
S3 = gallop rhythm due to rapid ventricular filling
Symptoms of RHF?
oedema
Signs of RHF?
ankle/sacral oedema
JVP elevated
hepatomegaly
ascites
What would you see on a CXR of RHF?
nothing, it good normal
How do you treat CCF due to previous MI or cardiomyopathy?
(standard medical treatment for CCF) Diuretics ACE inhibitors B-blockers Spironolactone Digoxin
What are the signs of interstitial fluid on CXR?
Kerley B lines
How do you treat CCF due to cor pulmonale?
Diuretics and O2 only:
e.g. furosemide (would also need K+ supplements) or spironolactone or ACE-I
What is the ideal therapy for CCF due to valvular disease?
surgery
How do you treat CCF due to fast AF?
digoxin or DC shock
Which diuretics help retain and normalise K+ concentration?
ACE inhibitors and spironolactone
Which type of diuretic would you use in mild CCF?
thiazide like diuretics
What are some of the side effects of ACE-Is?
angioneurmtic oedema
1st dose hypertension esp. if serum Na+ low
renal impairment
COUGH
Which drugs can be used instead of ACE-Is?
Angiotensin II receptor blockers
Give examples of ARBs
Losartan and Valsartan
What are the initial risks of using b-blockers in CCF?
worsening SOB
hypotension
Which receptor does spironolactone act on?
aldosterone receptor antagonist
What are some side effects of spironolactone?
hyperkalaemia
renal dysfunction
gynaecomastia
How does Ivabradine work and when would you use it?
blocks the pacemaker ‘funny current’
slow HR
only use if HR fast despite b-blocers
What are the steps of acute LVF therapy?
- Sit up patient
- O2 if hypoxic
- IV furosemide
- IV diamorphine
What is a biomarker for heart failure?
BNP
increased BNP distinguishes heart failure from other types of SOB
rises are greater with left over right sided, and with systolic over diastolic dysfunction
What is the role of ANP and BNP?
assist stretched atria and ventricles - reduce fluid load - relax SM - decrease preload.
