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Cardiology > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Define heart failure

A

Cardiac output is inadequate for the requirement of the body

- end stage of all heart disease

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2
Q

What are the classifications of heart failure

A 
Systole failure
Diastolic failure 
Left ventricular failure
Right ventricular failure
Congestive cardiac failure - most common
Acute heart failure
Chronic heart failure
Low output heart failure
High output heart failure
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3
Q

Describe systolic heart failure + causes

A 
Failure of adequate ventricular contraction resulting in decreased cardiac output 
Ejection fraction <40%
Causes
- ischaemic heart disease
- myocardial infarction 
- dilated cardiomyopathy
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4
Q

Describe diastolic heart failure + casues

A

Inability of ventricular relaxation, causing increased filling pressures and decreased cardiac output
EF >50% - heart failure with preserved EJ
Causes
- ventricular hypertrophy
- restrictive and hypertrophic cardiomyopathy
- cardiac tamponade
- constrictive pericarditis
- obesity

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5
Q

Describe left ventricular heart failure + symptoms

A 
Failure of the LV pump causing pulmonary congestion and oedema 
Symptoms
- dyspnoea
- decreased exercise tolerance 
- fatigue
- orthopnoea 
- nocturnal cough
- pink frothy sputum 
- wheeze
- nocturia 
- cold peripheries 
- weight loss 
- irregular, fast heart beat
- cyanosis
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6
Q

Describe right ventricular heart failure + causes

A 
Inability to pump adequate blood, causing systemic venous congestion
Causes 
- LVF (most common cause) 
- pulmonary stenosis
- lung disease
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7
Q

Signs and symptoms of right ventricular heart failure

A 
Peripheral oedema 
- raised JVP
- hepatosplenomeagly
- ankles and legs
Ascites
Nausea
Anorexia
Facial engorgement 
Epistaxis
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8
Q

Describe congestive cardiac failure (CCF)

A

Heart failure causes by the presence of both left and right ventricular failure

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9
Q

Describe acute heart failure + causes

A 
New-onset or decompensated chronic heart failure 
Causes
- post-MI
- persistent arrhythmia 
- ruptured valve 
- ventricular aneurysm 
- anaemia 
- electrolyte disturbance 
- thyrotoxicosis
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10
Q

Describe chronic heart failure

A

Heart failure that starts and progresses slowly

- can commonly lead to venous congestion, but maintains arterial pressure

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11
Q

Describe low out-put heart failure + causes

A

Low cardiac output which doesn’t increase with exercise
Causes
- excessive preload (MR, fluid overload)
- pump failure (systolic/diastolic HF, decreased heart rate or negatively inottopic drugs)
- chronic excessive afterload (AS, hypertension)

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12
Q

Describe high out-put heart failure + causes

A

Normal or increased cardiac output in the face of increased needs (anaemia, pregnancy, hyperthyroidism, Paget’s, AVM, beri-beri)
- rare

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13
Q

Complications of high out-put heart failure

A

RVF features - early

LVF features - late

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14
Q

How is heart failure diagnosed

A

Clinical - history, examination and investigations
Objective evidence of cardiac dysfunction at rest
For CCF - Farmingham criteria

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15
Q

What is the Farmingham criteria

A 
Diagnoses CCF based due to the presence of 2 major criteria, or 1 major and 2 minor criterion met
Major criteria 
- S3 heart sound 
- acute pulmonary oedema 
- weight loss on treatment 
- paroxysmal nocturnal dyspnoea
- abdominojugular reflex
- neck vein distension 
- increased cardiac shadow on CXR
- crackles in lungs 
Minor criteria
- hepatomeagly
- pleural effusion
- exertional dyspnoea 
- tachycardia 
- vital capacity less than 1/3 of max
- nocturnal cough
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16
Q

How is the severity of heart failure classified?

A

New York classification of HF

  • class 1 - no undue dyspnoea from normal activity
  • class 2 - slight limitation of ordinary activities
  • class 3 - severe limitation of any activity, comfortable at rest
  • class 4 - dyspnoea at rest
17
Q

What are the signs of heart failure?

A 
Hypotension 
Narrow pulse pressure 
Pulsus alternans 
Displaced apex - LV dilatation 
RV heave (pulmonary hypertension)
Valve disease 
Grade of severity
18
Q

Investigations for ?Heart failure

A

Bloods - FBC, U&Es, TFTs, LFTs and BNP
CXR - ABCDE
ECG - may show the cause (e.g. MI, LVH, ischaemia)
Echo
- ? cause (MI, valvular heart disease)
- LV function can be assessed
- detects ejection fraction, ventricular wall thickness and cardiac kinetics

If ECG and BNP are normal, it is likely not AF - try and find another cause

19
Q

What are the signs of heart failure on CXR

A

A- alveolar odedma - ‘bats wing’
B - kerley B-lines
C- cardiomeagly (more than half cardiothoracic ratio)
D- diversion or dilation of blood vessels to the upper lobe
E- pleural effusion

20
Q

What is the non-pharmacological management for chronic heart failure

A 
Exercise
Diet
- increase healthy food 
- decrease salt
- monitor weight 
Reduce alcohol - a cause of AF and heart failure 
Smoking cessation 
Flu vaccination
21
Q

Pharmacological management of chronic heart failure

A

ABCDD

ACEI
- reduces afterload and fluid retention (slows down LV disease)
- ARB if not tolerated
Beta-blockers
- reduces afterload and heart rate to prevent arrhythmias
- decreases mortality
- benefit additional to that of ACEI in systolic HF
Calcium-channel blockers
- only is ACEI and beta-blockers are ineffective and systolic HF is not the cause
Diuretics
- loop diuretics for symptoms (increased dose as required)
- add spironolcatone if hypokalaemia
- add thiazide if refractory oedema
Digoxin
- only considered if all above is inadequate
- indicated in patients with symptomatic sinus rhythm, severely impaired LVF or with recurrent hospital admissions

22
Q

Non-routine pharmacological management of chronic heart failure

A

Vasodilators

  • hydralazine and isosorbide mononitrate
  • if intolerant of ACEI and ARB
  • decreases mortality and standard therapy in black patients
23
Q

What are the 1st, 2nd and 3rd line medications used in chronic heart failure

A

Loop diuretics for symptoms at all stages
Calcium-channel blockers can be used (2nd line) if co-morbid hypertension and/or angina
1st line
- ACEI/ARB
- beta-blocker
2nd line
- spironolactone
- ARB (if not already on)
- hydralazine and isosorbide mononitrate (unless already on - black patients)
3rd line
- digoxin

24
Q

What surgical interventions are used in the management of chronic heart failure

A 
Depends on cause
Revascularisation therapy
- CABG or angioplasty 
Valve replacement 
LVAD
Implantable automatic cardiodefibrillator
- or pacemaker for arrhythmias
Transplant
25
Q

What is an LVAD

A

Left ventricular assist device

  • bridging therapy for patients awaiting a heart transplant
  • internalised pump forces blood through tubing that travels from the left ventricle, to the aorta
  • no pulse
  • loud, continuous mechanical hum on ausculation
26
Q

Differentials for acute heart failure

A

Asthma/COPD
Pneumonia
Pulmonary oedema
- if patient is unwell and you are unsure, treat all 3
- salbutamol neb, furosmide IV, morphine and amoxicillin

27
Q

Management of acute heart failure

A

Sit patient upright
High flow oxygen
IV access and ECG monitoring - treat arrhythmias
Morphine
- CI in liver failure and COPD
IV furosemide
2 puffs of GTN or tablets (unless hypotensive)
Nitrate infusion
- isosorbide dinitrate IV
Worsening
- another dose of furosemide
- consider CPAP (drives fluid out of the alveoli)
- increase nitrate infusion
- consider alternative diagnosis
If BP <100mmHg systolic, treat as cardiogenic shock and refer to ICU

Cardiology (13 decks)

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