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Week 5 - Phase 3 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is heart failure?

A

Failure of heart to pump blood to provide oxygen at a sufficient rate to meet the metabolic requirements of tissues.

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2
Q

What causes of HF are common in the UK?

A
  • CHD
  • hypertension
  • toxins (alcohol, chemo)
  • genetic
  • idiopathic
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3
Q

What causes of HF are less common in the UK?

A
  • valve disease
  • infections (virus, chaga’s)
  • congenital disease
  • metabolic (amyloid, thyroid, haemochromotisis)
  • pericardial disease
  • endocardial disease
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4
Q

What are the main types of HF?

A
  • HF with reduced ejection fraction (systolic HF)
  • HF with preserved ejection fraction (diastolic HF)
  • Chronic congestive
  • Acute decompensated.
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5
Q

Describe HF-REF?

A
  • heart muscle cant contract adequately and expels less O2 rich blood to the body
  • have low left ventricular ejection fraction
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6
Q

Who is more likely to get HF-REF??

A
  • younger patients
  • males
  • coronary aeitiology
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7
Q

Who is more likely to get HF-PEF?

A
  • older patients
  • more often female
  • hyprtensive aeitiology
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8
Q

Describe the pathophysiology of HF?

A
  1. Can be due to myocardial injury.
  2. Left ventricular diastolic dysfunction.
  3. Reduction in circulating volume and pressure.
  4. Neurohumoral activation
    - SNS
    - RAAS
    - Naturietic peptides
    - Anti-diuretic hormone
  5. Systemic vasoconstriction and Renal sodium and water retention.
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9
Q

List symptoms of HF?

A
  • fatigue
  • dyspnoea
  • orthopnoea
  • Paroxysmal nocturnal dyspnoea
  • oedema
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10
Q

List signs of HF?

A
  • oedema
  • raised JVP
  • 3rd heart sound
  • displaced heart beat (cardiomegaly)
  • pulmonary oedema (crackles)
  • pleural effusion
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11
Q

What system is used to classify heart failure?

A

New York Heart Association Functional Classification

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12
Q

Describe the categories of the NYHA classification?

A

I: No symptoms and no limitation in normal activity.
II: Mild symptoms and slight limitation in activity.
III: Marked limitation in activity due to symptoms, only comfortable at rest.
IV: Severe limitation, have symptoms at rest. Mostly bed bound.

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13
Q

What investigations would all patients get for HF?

A
  • ECG
  • CXR (pulmonary oedema)
  • Echo (chamber size, systolic/diastolic function)
  • Bloods: FBC, U&E, LFT’s, ureate, Hb.
  • Naturitic peptides: BNP, NT-proBNP.
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14
Q

What investigations do selected HF patients also get?

A
  • Coronary angiography
  • exercise test
  • ambulatory ECG monitoring
  • myocardial biopsy
  • genetic testing.
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15
Q

How do we diagnose HF?

A
  1. See S+S of HF
  2. Clinical examination (bloods, imaging etc)
  3. Test BNP/NT-proBNP and do ECG.
  4. If low BNP and normal ECG = HF excluded and look for other possibilites.
    If high BNP or abnormal ECG = Refer or echo = decide future management.
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16
Q

What is the treatment of HF according to the sign guidelines?

A
  1. B-blocker + ACEi/ARB
  2. B-blocker + ACEi + MRA
    - seek specialist advice -
  3. Sucubitril/valsartan + B-blocker + MRA
    (stop ACEi/ARB)
  4. ICD or CRT in selected patients.
    Ivabradine if HR >75 bpm.
  5. Digoxin
  6. Refer to national transplant unit for assessment for LVAD or transplant.
17
Q

Describe the RAAS?

A
  1. Angiotensinogen from liver is converted to angiotensin 1 by renin (from kidney)
  2. AT1 is converted to AT2 by ACE from the lungs.
  3. AT2 acts to cause;
    - Blood vessel vasoconstriction
    - Sodium and water retention in the kidney
    - Cell hypertrophy and fibrosis in the heart
    - Aldosterone secretion from the adrenal gland (salt and water retention).
    - Sympathetic activation and vasopressin secretion in the brain.
18
Q

What are ICD’s and how are they used?

A

Implantable Cardioverter Defibrillator

  • implanted under skin in upper left chest.
  • con perform cardioversion to turn an arrhythmia to a normal rhythm and can also pace the heart.
19
Q

What is CRT and how does it work?

A

Cardiac resynchronisation therapy.

  • implanting a pacemaker below the clavicle.
  • 3 wires connect electrodes to the left and right ventricles and the right atrium.
  • Irregularities can be resynched.
  • Also used in HF with a prolonged QRS where there is a low ejection fraction.
20
Q

Why is ivabridine used?

A

Acts to inhibit the If channel (NA+ and K+ both moving inward) in the SA node.
This inhibits the SA node and slows HR.

21
Q

Describe how ventricular assist devices work?

A
  • Assists cardiac circulation by partially or completely replacing the function of the heart.
  • Can be used short term e.g. after cardiac surgery.
  • Can be used long term e.g. advanced congestive heart failure.
  • Can assist left ventricle (LVAD), right ventricle (RVAD) or both venricles (BiVAD).
22
Q

How do we treat HF-PEF?

A

No evidence based treatments.

Thought MRA may decrease hospital admissions.

23
Q

If in acute HF what must we check for?

A
  • Cardiogenic shock

- Respiratory failure.

24
Q

How do we treat cardiogenic shock?

A

Ionotropes and mechanical circulatory support.

25
Q

How do we treat respiratory failure?

A

Ventilate with oxygen
Positive pressure ventilation
Mechanical ventilation.

26
Q

Describe the aeitiology of acute HF?

A
  • acute coronary syndrome
  • hypertension emergency
  • arrhythmia
  • acute mechanical cause
  • pulmonary embolism

CHAMP

27
Q

What are the types of acute HF?

A
  1. warm-dry: no congestion or hypoperfusion.
  2. cold-dry: no congestion but there is hypoperfusion.
  3. warm-wet: Congestion, but no hyperfusion.
  4. warm-dry: Congestion AND hypoperfusion.
28
Q

Describe ‘congestion’ in acute HF?

A
  • pulmonary congestion
  • orthoponea
  • peripheral oedema
  • jugular venous dilation
  • congested hepatomegaly
  • ascites
  • hepatojugular reflux.
29
Q

Describe ‘hypoperfusion’ in acute HF?

A
  • cold, sweaty extremities
  • oliguria
  • mental confusion
  • dizziness
  • narrow pulse pressure
30
Q

How do we treat warm-dry acute HF?

A

adjust oral therapy

31
Q

How do we treat cold-dry acute HF?

A

fluids and ionotropes

32
Q

How do we treat warm-wet acute HF?

A

vasodilators and diuretics

33
Q

How do we treat cold-wet acute HF?

A
  • if systolic BP is <90mmHg = ionotropes, diuretics, mechanical circulatory support.
  • if systolic BP is >90mmHg: ionotropes, diuretics, vasodilator.
34
Q

Give examples of ionotopes?

A

Dopamine
Milrinone
Dobutamine

35
Q

How do ionotropes work?

A

Increase the strength of muscle contraction.

Week 5 - Phase 3 (7 decks)

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