Heart Failure Flashcards
What is heart failure?
Failure of heart to pump blood to provide oxygen at a sufficient rate to meet the metabolic requirements of tissues.
What causes of HF are common in the UK?
- CHD
- hypertension
- toxins (alcohol, chemo)
- genetic
- idiopathic
What causes of HF are less common in the UK?
- valve disease
- infections (virus, chaga’s)
- congenital disease
- metabolic (amyloid, thyroid, haemochromotisis)
- pericardial disease
- endocardial disease
What are the main types of HF?
- HF with reduced ejection fraction (systolic HF)
- HF with preserved ejection fraction (diastolic HF)
- Chronic congestive
- Acute decompensated.
Describe HF-REF?
- heart muscle cant contract adequately and expels less O2 rich blood to the body
- have low left ventricular ejection fraction
Who is more likely to get HF-REF??
- younger patients
- males
- coronary aeitiology
Who is more likely to get HF-PEF?
- older patients
- more often female
- hyprtensive aeitiology
Describe the pathophysiology of HF?
- Can be due to myocardial injury.
- Left ventricular diastolic dysfunction.
- Reduction in circulating volume and pressure.
- Neurohumoral activation
- SNS
- RAAS
- Naturietic peptides
- Anti-diuretic hormone - Systemic vasoconstriction and Renal sodium and water retention.
List symptoms of HF?
- fatigue
- dyspnoea
- orthopnoea
- Paroxysmal nocturnal dyspnoea
- oedema
List signs of HF?
- oedema
- raised JVP
- 3rd heart sound
- displaced heart beat (cardiomegaly)
- pulmonary oedema (crackles)
- pleural effusion
What system is used to classify heart failure?
New York Heart Association Functional Classification
Describe the categories of the NYHA classification?
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.
What investigations would all patients get for HF?
- ECG
- CXR (pulmonary oedema)
- Echo (chamber size, systolic/diastolic function)
- Bloods: FBC, U&E, LFT’s, ureate, Hb.
- Naturitic peptides: BNP, NT-proBNP.
What investigations do selected HF patients also get?
- Coronary angiography
- exercise test
- ambulatory ECG monitoring
- myocardial biopsy
- genetic testing.
How do we diagnose HF?
- See S+S of HF
- Clinical examination (bloods, imaging etc)
- Test BNP/NT-proBNP and do ECG.
- 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.
What is the treatment of HF according to the sign guidelines?
- B-blocker + ACEi/ARB
- B-blocker + ACEi + MRA
- seek specialist advice - - Sucubitril/valsartan + B-blocker + MRA
(stop ACEi/ARB) - ICD or CRT in selected patients.
Ivabradine if HR >75 bpm. - Digoxin
- Refer to national transplant unit for assessment for LVAD or transplant.
Describe the RAAS?
- Angiotensinogen from liver is converted to angiotensin 1 by renin (from kidney)
- AT1 is converted to AT2 by ACE from the lungs.
- 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.
What are ICD’s and how are they used?
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.
What is CRT and how does it work?
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.
Why is ivabridine used?
Acts to inhibit the If channel (NA+ and K+ both moving inward) in the SA node.
This inhibits the SA node and slows HR.
Describe how ventricular assist devices work?
- 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).
How do we treat HF-PEF?
No evidence based treatments.
Thought MRA may decrease hospital admissions.
If in acute HF what must we check for?
- Cardiogenic shock
- Respiratory failure.
How do we treat cardiogenic shock?
Ionotropes and mechanical circulatory support.
