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Cardiovascular Diseases > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

How do you assess if a patient has acute heart failure?

A
  • Clinical exam
  • Standard investigations (see CHF)
  • Single measurement of serum natriuretic peptides (ruled out if B-type natriuretic peptide less than 100 ng/litre or N-terminal pro-B-type natriuretic peptide less than 300 ng/litre.)
  • Perform transthoracic Doppler 2D echocardiography to establish the presence or absence of cardiac abnormalities
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2
Q

What assessments do you do if you suspect a patient has chronic heart failure?

A
  • Suspected heart failure and previous MI referred urgently to have transthoracic Doppler 2D echocardiography and specialist assessment within 2 weeks.
  • Measure serum natriuretic peptides if no previous MI
  • ECG and further rests for aggravating factors
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3
Q

What can impact levels of serum natiuretic peptides?

A
  • Obesity
  • Diuretics
  • ACEIs
  • ß blockers
  • ARBs
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4
Q

What can a transthoracic doppler 2D echocardiography potentially do when assessing heart failure?

A
  • Exclude important valve disease
  • Assess the systolic (and diastolic) function of the (left) ventricle
  • Detect intracardiac shunts.
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5
Q

What is the initial pharmacological and non-pharmalogical treatment for acute heart failure? What is the aim of this?

A
  • IV diuretics (normally loop)
  • non-invasive ventilation if cardiogenic pulmonary oedema with severe dyspnoea and acidaemia
  • Aim is to stabilise
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6
Q

What is the treatment after stabilisation of acute heart failure?

A
  • ß blockers
  • ACEIs and aldosterone antagonists
  • Valve replacement (if aortic stenosis)
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7
Q

What is the non-surgical management of chronic heart failure?

A
  • Lifestyle advice
  • Diuretics
  • CCBs - amlodipine (not others)
  • Amiodarone (consult with specialist)
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8
Q

What surgical procedures can be offered for chronic heart failure?

A
  • Coronary revascularisation - with angina
  • Partial left ventriculectomy
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9
Q

What is the treatment route for patients with chronic heart failure due to left ventricular systolic dysfunction?

A
  • First line - ACEIs (can use ARB as alternative) and ß blockers
  • Second line - aldosterone antagonist, hydralazine with nitrate
  • Third line - digoxin, ivabradine
  • Can use ICDs
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10
Q

Give an overview of what heart failure is and the types.

A
  • Congestive cardiac failure (CCF) syndrome - not one disease
  • Due to low cardiac output in most cases
  • Left, right, mixed
  • Acute (especially LVF), chronic
  • Signs and symptoms due to fluid retention
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11
Q

What are the main causes of L sided heart failure?

A
  • IHD - MIs
  • Cardiomypoathy
  • Valvular disease
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12
Q

What are the main causes of R sided heart failure?

A
  • Often secondary to R sided heart failure (often mixed)
  • Cor pulmonale
  • Congenital heart disease
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13
Q

What are the symptoms of L heart failure?

A
  • Dyspnoea on exertion/rest
  • Orthopnea
  • Paroxysmal nocturnal dyspnoea
  • Pulmonary oedema (sudden dyspnoea, pink frothy sputum
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14
Q

What are the physical exam signs of L sided heart failure?

A
  • Tachycardia
  • Fine crepitations
  • Pleural effusion
  • S3 (gallop rhythm = S3 + tachycardia)
    *
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15
Q

What are the CXR findings for L sided heart failure?

A
  • Cardiomegaly
  • Bat wing shadows - especially lower zones
  • Interstitial fluid
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16
Q

What are the symptoms and signs of R sided heart failure?

A

Symptoms

  • Oedema

Signs

  • Oedema (ankle/sacral)
  • JVP elevated (>4cm above sternal angle)
  • Hepatomegaly
  • Ascites
17
Q

What are the CXR findings of R sided heart failure?

A
  • None
18
Q

What three causes of heart failure require specific therapies?

A
  • Cor Pulmonale - Rx diuretics and oxygen only
  • Valvular Disease - Surgery ideally
  • Fast AF - Digoxin or DC shock
19
Q

What is the acute LVF instant pathway?

A
  1. Sit up
  2. Oxygen
  3. IV furosemide
  4. IV diamorphine (not in COPD)
20
Q

What are the stages of the New York Heart Association functional classification of Heart Failure?

A
  • Class I - No limitation
  • Class II - Slight limitation of ordinary activity
  • Class III - Marked limitation of less than ordinary activity
  • Class IV - Severe limitation of minimal activity or at rest

Cardiovascular Diseases (9 decks)

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