Heart failure Flashcards
What are the causes of HF?
IHD
Cardiomyopathy
HTN
What are the sx of chronic HF;
dyspnoea malaise cold peripheries leg swelling ankle oedema cough - frothy pink sputum Exertional dyspnoea orthopnoea paroxysmal nocturnal dyspnoea cardiac wheeze
What are the signs of chronic HF?
- Tachycardia
- Displaced apex beat
- Elevated JVP
- Cardiomegaly
- 3rd and 4th HS
- Bibasal crackles
- Pleural effusion
- Peripheral ankle oedema
Explain the NYHA classification of HF
Class I - no sx, no limitation of ordinary physical activity
II - mild, slight limitation during ordinary activity
III - marked limitation on activity due to sx, some at rest (dyspnoea, fatigue, palpitations)
IV - severe limitation, sx at rest, mostly bed bound
What are the ix for hf, give results you’d find in HF
FBC U&Es - renal function NT-proBNP ECG Echo XR - cardiomegaly, Kerley B lines, pulmonary congestion
What is the management of suspected HF w a prev MI?
echo in 2 weeks
What is the management of suspected HF w no prev MI?
measure BNP
What is NT-proBNP
Hormone produced by LV myocardium in response to strain
What is the management of NT-proBNP <400ng/L
unlikely HF, review for alternative causes
What is the management of NT-proBNP of 400-2000ng/l
specialist assessment and echo in 6 weeks
What is the management of NT-proBNP of >2000ng/l
assessment and echo in 2 weeks
What are the other causes of raised NT-proBNP?
>70yrs LV hypertrophy RV overload Ischaemia Hypoxaemia Tachycardia Sepsis COPD DM Cirrhosis Renal dysfunction <60 egfr
What are the causes of reduced NT-proBNP?
obesity african Caribbean Diuretics ACEi BB ARBs aldosterone antagonists
What is the 1st line pharmacological management of HF w a reduced ejection fraction
ACEi - ramipril
BB - atenolol
What is given if ACEi aren’t tolerated?
ARB - losartan
What needs to be monitored when giving ARBs
Na
K
Renal function
What can be added to first line treatment of HF if sx persist>
Mineralocorticoid receptor antagonists (spironolactone) Ivabradine Sacubitril valsartan Hydralazine + nitrate Digoxin (AF)
what are the conditions for giving Ivabradine and sacubitril valsartan?
class II-IV NYHA
Sinus rhythm >75bpm
LV ejection fraction <35%
What are medications given to all HFs?
diuretics - loop - furosemide for relief of congestive sx and fluid retention
CCB -amlodipine
Amiodarone - LFTs, TFTs
Anticoagulants - HF and AF
What are the surgical options for rx of HF?
Cardiac transplant if severe refractory sx, refractory cardiogenic shock
What is acute HF?
Sudden onset or worsening of sx of HF
What age does acute HF usually present?
> 65
What are precipitating causes of acute hF?
acute coronary syndrome
hypertensive crisis
acute arrhythmia
valvular disease
What are the features of acute HF?
Fluid congestion signs weight gain orthopnoea dyspnoea cyanosis increased HR, JVP Displaced apex beat S3 HS
What are the investigations in acute HF and why?
bloods - look for underlying abnormality e.g. anaemia, inf
CXR - pulmonary venous congestion, interstitial oedema, cardiomegaly
Echo - pericardial effusion, cardiac tamponade
BNP - >100mg/l - myocardial damage
What is the management of acute HF?
Initial: Diuretics, closely monitor renal function, weight and UO during diuretics
Do not routinely offer: Opiates, nitrates, inotropes or vasopressors, sodium nitroprusside
After stabilising: If already on BBs, continue unless HR <50bpm, 2nd/3rd degree AV block or shock, offer ACEi and aldosterone antagonist
