Heart Failure Flashcards
What is heart failure
Cardiac output is inadequate to meet body’s requirements
What are the classifications of heart failure
Systolic, Diastolic
Right, Left, congestive
Acute, Chronic
Low output, High output
What is systolic failure
What are it’s causes
Inadequate CO due to failure to contract
Ejection fraction <40%
IHD, MI, cardiomyopathy
What is diastolic failure
What are the causes
Inadequate CO due to failure to relax and fill
Heart failure with preserved ejection fraction (>50%)
Ventricular Hypertrophy, Restrictive cardiomyopathy, constrictive pericarditis, Cardiac tamponade
How does left ventricular failure present
Dyspnoea Poor exercise tolerance Orthopnoea Paroxysmal nocturnal dyspnoea Wheeze Nocturnal cough Pink frothy sputum Bibasal crackles Cold peripheries
How does right ventricular failure present
What are the causes
Peripheral oedema, ascites, raised JVP, facial engorgement, anorexia
LVF (most common), lung disease(cor pulmonale), pulmonary stenosis
What is acute failure
New onset acute heart failure
Decompensated chronic heart failure
Characterised by pulmonary/peripheral oedema +/- peripheral hypoperfusion
What is chronic heart failure
Heart failure develops gradually
Characterised by venous congestion but arterial pressure maintained
What is low output heart failure
What are the causes
Cardiac output low and cannot increase to meet needs
Excessive preload: mitral regurge, fluid overload
Pump failure: systolic, diastolic, chronotropy (post mi, heart block, beta blocker), negative inotropic Drugs
Excessive afterload: AS, HTN
What is low output heart failure
What are the causes
Normal cardiac output but cannot meet significantly increased needs
Anaemia, pregnancy, thyrotoxicosis, Paget’s disease
What are signs of heart failure
Cyanosis Hypotension Pulsus Alternans: beat to beat alternating pulse pressure Third heart sound Displaced apex beat RV heave Murmur
How do you assess severity of heart failure symptoms
New York classification of heart failure:
I: no dyspnoea from ordinary activity
II: dyspnoea from ordinary activity
III: dyspnoea from less than ordinary active
IV: dyspnoea at rest
What is required for diagnosis of HF
Symptoms Objective evidence: BNP ECG Echo - further Ix if either are abnormal
What investigations do you order for heart failure
FBC, U+E, BNP
ECG
CXR
Echo
What are possible ecg changes
Ischaemia
Past MI
Ventricular Hypertrophy
Rarely normal in chronic HF
What are findings on CXR for heart failure
Alveolar oedema: perihilar shadowing, batwing appearance
Kerely B lines - septal lines, interstitial oedema
Cardiomegaly - cardiothoracic ratio >50%
Dilated upper lobe veins
Pleural Effusion
What will you assess on echocardiography
Cause: MI, cardiomyopathy, valve disease LV dysfunction (EDV - high = systolic failure)
What is BNP
What is its role
Brain natriuretic peptide, hormone released from Ventricular myocardium when stretched
Assist stretched ventricles:
Increase GFR, decrease Na reabsorption, decrease fluid load - decrease preload
Vasodilation - decrease afterload
What is the clinical use of BNP
Biomarker: distinguish from other causes of dyspnoea/LV ejection fraction
Diagnosis of heart failure: >100ng diaonstic
Levels correlate with mortality
What are steps of management of acute heart failure
Sit patient upright High flow O2 (if hypoxic) Diamorphine IV Furosemide IV GTN spray/SL tablets Nitrate infusion (keep BP >90) CPAP (if worsening on furosemide)
What are differential diagnoses of acute heart failure
How do you manage this
Pneumonia
COPD
Asthma
Treat for all three: amoxicillin, IV furosemide, salbutamol nebuliser
What is pharmacological management of chronic heart failure
Diuretics ACE-Inhibitor Beta-blocker Mineralocorticoid receptor antagonists Digoxin Vasodilator
What diuretics are used
Why
Furosemide P.O.
Add on metolazone if refractory oedema
Add on spironolactone if hypokalaemic
Improves symptoms
What is the role of ace inhibitors
For all with LVSD
Improves mortality
