Heart Failure Flashcards
Top 5 causes of HF
IHD HTN Valvular heart disease Cardiomyopathy Arrhythmias
4 pathophysiology points which compensate initially
- Starling forces causes heart dilation
- Remodelling (hypertrophy)
- RAAS activation
- Sympathetic activation
Main causes of HF
- Pump failure
- Excessive preload
- Excessive afterload
- High-output failure
- Isolated RHF
Pump failure subdivisions
Systolic
Diastolic
Arrhythmic
Systolic heart failure causes
IHD Dilated CM HTN Myocarditis Negatively inotropic drugs
Diastolic heart failure causes
HOCM
Pericardial effusion/tamponade
Restrictive pericarditis
Arrhythmic causes of heart failure
Heart block
Brady/tachycardia
Anti-arrhythmic drugs
Causes of excessive preload
AR
MR
Fluid overload
Causes of excessive afterload
AS
HTN
HOCM
Causes of high-output failure
Anemia
Pregnancy
Metabolic; hyperthyroidism, Paget’s
Causes of isolated RHF
Cor pulmonale
Tricuspid/pulmonary valve dysfunction
Isolated pulmonary HTN
HF symptoms
Fatigue Exertional dyspnoea PND Orthopnoea Nocturnal cough (+ pink frothy sputum) Weight loss Muscle wasting
Acute vs chronic HF
Acute: pulmonary oedema +.- systemic hypoperfusion
Chronic: evidence of venous congestion
Signs of venous congestion
Raised JVP
Smooth, tender hepatomegaly
Pitting/peripheral oedema
Ascites
Heart failure criteria
Framingham (2 major or 1 major +2 minor)
Investigations
Bloods (FBC, U&E, BNP)
ECG
CXR
Echo
What features can be assessed on echocardiography?
Systolic/diastolic function Areas of hypomotility/dyskinesia Vegetations Valve function Hypertrophy Intracardiac shunts
What level of BNP excludes HF?
<100
NHYA classification
- No limitation of activity
- Comfy at rest, slight limitation with activity.
- Marked limitation of ordinary activity.
- Discomfort + dyspnoea @ rest.
1st line management of HF
ACEIs/ARBs
Beta-blockers (start LOW, go SLOW)
Loop diuretics
Sacubitril
Neprilysin inhibitor (prevents breakdown of BNP)
What is Entresto?
ARNI = angiotension receptor and neprilysin inhibitor
Valsartan + sacubtril
How do you reduce CV risk (primary/secondary prevention)?
Stop smoking Optimise diet and weight loss Exercise rehab Reduce salt intake Aspirin and statins
Invasive HF treatment options
Cardiac resynchronisation ICD LVAD Intra-aortic balloon pump Heart transplant
What are the 5 main causes of RVF?
COPD Left ventricular failure Volume overload (e.g. tricuspid regurg) Pressure overload (e.g. PHTN, pulmonary stenosis) Myocardial disease (e.g. RV MI)
