Heart Failure Flashcards
What is systolic heart failure and what are the causes?
Inability of the heart to contract normally causing an ejection fraction of less than 40%
It is caused by IHD, MI and cardiomyopathy
What is diastolic heart failure and what are the causes?
Inability of the ventricle to relax and fill properly. Typically ejection fraction is >50%, this is term HF-PEF (heart failure with preserved ejection fraction) Caused by: Ventricular hypertrophy Tamponade Constrictive pericarditis Restrictive cardiomyopathy Obesity
What are the symptoms for left ventricular failure?
Dyspnoea Poor exercise tolerance Fatigue Orthopnoea Frothy sputum Paroxysmal nocturnal dyspnoea
What are the symptoms for right ventricular failure?
Peripheral oedema
Ascites
Nausea
Facial engorgement
What causes right ventricular failure?
Left ventricular failure
Pulmonary stenosis
Cor pulmonale
What are the causes of low ouput heart failure?
Excessive preload e.g. mitral regurge or excessive preload
Pump failure e.g. systolic and/or diastolic heart failure, decreased heart rate e.g. beta blockers, negatively inotropic drugs e.g. antiarrhythmic
Chronic excessive afterload e.g. aortic stenosis, hypertension
What is high output heart failure?
It is very rare and is the increased needs of the body which the heart is then not able to meet e.g. anaemia, pregnancy and hyperthyroidism
How is heart failure diagnosed?
Through a combination of symptoms and objective evidence of cardiac dysfunction at rest
What are some of the signs of heart failure?
Increased BP Decreased pulse pressure RV heave Displaced apex (LV dilation) Signs of valve disease
What are the investigations for heart failure?
ECg and BNP
Echo is the key investigation
What are the ranges for BNP and pro BNP for heart failure?
Greater than 100ng/L for BNP and greater than 400 for proBNP
What are the features of a chest x ray in left ventricular failure?
A - Alveolar oedema B - Kerley B lines C - Cardiomegaly D - Dialated upper lobe vessels E - Pleural effusions
What are the main forms of pharmacological treatment of chronic heart failure?
Diuretics - loop diuretics e.g. furosemide
ACE-I
Beta blockers e.g. cardedilol
mineralocorticoid receptor antagonists e.g. spironolactone
Digoxin
Vasodilators e.g. hydralazine
How should acute heart failure be managed?
Begin treatment before investiagtions Sit patient upright High flow oxygen if low sats IV access and monitor ecg Treat any arrhythmias Diamorphine 1-5mg IV slowly- caution in COPD and liver failure Furosemide 40-80mg IV slowly GTN spray - not if systolic <90 Start investigations If systolic above 100 then start nitrate infusion (isosorbide dinitrate)
In patients where medical therapy is not sufficient for heart failure what are the options?
Biventricular pacing can improve symptoms
Assist devices are automatic pumps that take over the work of the heart, usually to bridge transplantation
Transplant for end stage HF
