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IPE revision CARDIOLOGY > heart failure > Flashcards

heart failure Flashcards

1
Q

define heart failure

A

Inability of the heart to adequately pump supply in relation to the bodies demands

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2
Q

explain the different types of heart failure

A

Systolic vs Diastolic

  • systolic = impaired contraction
  • diastolic = impaired filling

left vs right

low output vs high output

  • low output = pump failure, diastolic failure, arrhythmias
  • high output = pregnancy, anaemia, thyrotoxicosis
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3
Q

what are the causes of systolic heart failure?

A

MI/ischaemia (commonest)

dilated cardiomyopathy

HTN

myocarditis

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4
Q

what are the causes of diastolic HF?

A

pericardial effusion

Tamponade

restrictive/hypertrophic cardiomyopathy

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5
Q

how do the causes of right heart failure and left heart failure differ?

A

…

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6
Q

what is the difference between low vs high output heart failure?

A

In low output CO falls and the heart fails to increase exertion - LVF

In high output there is an increased demand on the heart - RVF first then LVF

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7
Q

how do arrhythmias cause heart failure?

A

uncoordinated contraction leads to decreased CO to supply the bodies demands

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8
Q

describe the physiological responses to heart failure

A

Baroreceptors detect low CO and stimulate sympathetic drive to vasoconstrict, increase HR and activate RAAS

decreased CO leads to decreased renal perfusion and RAAS activation

BNP released due to stretch causes naturesis to reduce fluid and strain on heart by relaxing smooth muscle

Myocyte hypertrophy - match demand

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9
Q

explain starlings curve in heart failure

A

Normally increase in preload increases CO but in heart failure the peak is reached earlier. In mild heart failure this reduced CO will be compensated for by increased HR.
However, later the heart cannot keep up with the bodies demands and the curve shifts

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10
Q

what is the NYHA classification for HF?

A

Class I – no limitation / breathless on physical activity. But heart disease present

Class II – some limitation

Class III – marked limitation

Class IV – symptoms at rest

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11
Q

what are the symptoms of heart failure (Split up into left and right sided)

A

left = fatigue, exertional dyspnoea, orthopnoea, PND

right = fatigue, dyspnoea, anorexia/nausea, peripheral oedema, ascites

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12
Q

what are the signs of heart failure

A

left = cardiomegaly and shifted apex, crackles, 3rd/4th heart sounds, murmur, cool peripheries, low BP, tachycardia

right = hepatomegaly, ascites, raised JVP, cardiomegaly
Kussmaul sign – seen in diastolic HF whereby there is a paradoxical rise in JVP with inspiration or failure of JVP to drop with inspiration

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13
Q

what are the complications of heart failure?

A

Low CO

Muscle underpurfusion – weakness, exercise intolerance, fatigue

Poor renal perfusion can lead to CKD

Pulmonary oedema

Arrhythmias – due to tissue remodelling

Risk of VTE and stroke due to stasis and arrhythmias

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14
Q

What crtieria is used to diagnose heart failure?

A

Framingham criteria - need 2major or 1major + 2minor

MAJOR: (3 lung, 3 heart, 3 peripheral)
PND
Lung crepitations
Acute pulmonary oedema
Cardiomegaly
S3 gallop rhythm 
Increased central venous pressure
Neck vein distension
Hepatojugular reflux
Weight loss in response to treatment 
MINOR: (3 lung, 1 heart, 2 enlargements) 
Dyspnoea
Nocturnal cough
Plural effusion
Tachycardia
Bilateral ankle oedema
Hepatomegaly
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15
Q

what investigations would you want to carry out in someone presenting with HF?

A

bloods: FBC (anaemia), U&E (kidney function), BNP, TFT

CXR

ECG - axis deviation, ischaemia

ECHO - assess LV function, heart structure, valve disease, ejection fraction

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16
Q

what can an ECHO tell you in HF?

A

Assess LV function

LV wall thickness

ejection fraction

valve disease

17
Q

what does NICE suggest about diagnosis of HF based on ECG, ECHO and BNP?

A

If ECG and BNP both normal – HF is unlikely

If abnormal then ECHO required to confirm diagnosis

If very high BNP – 2 week referral for ECHO

If moderately high – 6 week referral for ECHO

18
Q

what are the classical CXR seen in HF

A 
Alveolar shadowing – bat wings 
Kerley B lines
Cardiomegaly
Upper lobe Diversion 
Effusions
19
Q

Discuss the steps in managing heart failure

A
  1. conservative
    - manage risks e.g. smoking, BMI, salt intake
    - exercise rehab
    - vaccinations
    - avoid certain drugs e.g. NSAIDs, verapamil
  2. correct any underlying cause
  3. Pharma
    - protective = aspirin and statins
    - 1st line = ACEi/ARB (Lisinopril/Candesartan), b-blocker, loop diuretic
    - 2nd line - get specialist help (spironolactone etc)
    - 3rd line = digoxin
    - anticoag also should be considered
  4. Surgery
    - cardiac resync (pacemaker)
    - implantable cardioverter defib
    - CABG/angioplasty
    - LV assist device
    - transplant
20
Q

which medications actually improve prognosis for HF (rather than just symptom control) ?

A

ACEi
B blockers
Spironolactone

21
Q

what are the causes of pulmonary oedema?

A

Cardiogenic:
- MI, arrhythmia, fluid overload

non-cardio:
- ARDS, airway obstruction, neurogenic

22
Q

how can acute HF / pulmonary oedema occur?

A

New onset OR decompensation of chronic HF
Anything which makes the HF situation worse

Causes of acute HF – CHAMP
Coronary syndrome
Hypertensive emergency 
Arrhythmias 
Mechanical – VSD, valve leak, LV aneurysm
P.E
23
Q

what are the symptoms of acute HF/ pulmonary oedema ?

A

acute breathlessness
cough/pink frothy sputum
collapse/arrest

24
Q

what are the signs of acute HF/ pulmonary oedema?

A 
distressed, sweaty, cyanosed
anxiety
increased HR + RR
increased JVP
S3 gallop rhythm
bibasal creps
pleural effusions
wheeze (cardiac asthma)
25
Q

Discuss step wise management of pulmonary oedema / Acute HF

A
  1. sit patient upright
  2. O2 high flow (94-98%)
  3. IV access and ECG
  4. diamorphine 5mg IV + metoclopramide 10mg IV (calm patient + venodilator)
  5. Furosemide 40-80mg IV
  6. GTN
    7 if worsening consider CPAP, ITU, dialysis, more furosemide
26
Q

what are the causes of a raised BNP?

A 
HF
MI
Athletes 
P.E
CKD or AKI
Sepsis 
COPD with cor pulmonale
Hyperthyroidism
27
Q

what is restrictive cardiomyopathy?

A

Ventricular walls become rigid

diastolic dysfunction

least common type of cardiomyopathy

28
Q

what is hypertrophic cardiomyopathy?

A

thickened left ventricular wall, with reduced ventricular lumen size

diastolic dysfunction

risk of sudden cardiac death in the young

29
Q

what is congestive cardiomyopathy?

A

enlargement of all 4 heart chambers of the heart

most common type

systolic dysfunction

30
Q

how can we distinguish between COPD exacerbation and pulmonary oedema?

A

Both have breathlessness but:

COPD – red due to vasodilation

Acute HF – cold, clammy and pale

31
Q

what are the causes of acute HF?

A

Causes of acute HF – CHAMP

  • Coronary syndrome
  • Hypertensive emergency
  • Arrhythmias
  • Mechanical – VSD, valve leak, LV aneurysm
  • P.E

IPE revision CARDIOLOGY (9 decks)

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