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Cardiovascular (Annie) > Heart failure > Flashcards

Heart failure Flashcards

1
Q

what are the 8 phases of heart failure?

A

1) risk factors = diabetes & hypertension
2) atherosclerosis & LVH
3) MI
4) remodelling
5) ventricular dilation
6) congestive heart failure
7) end stage heart disease & death
8) death

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2
Q

what is heart failure?

A

state in which the heart is unable to pump blood at a rate commensurate with the requirements of the tissues or can do so only at high pressure

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3
Q

what 2 impairments to the heart cause heart failure?

A

1) impairment of left ventricular filling

2) impaired ejection of blood

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4
Q

what happens in impaired left ventricular filling?

A

= in diastole, left ventricle walls relax allowing for filling of LV cavity
= without proper LV relaxation, the volume of blood filling the cavity is reduced, thus reducing SV, the volume of blood ejected with each contraction

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5
Q

what happens in impaired ejection of blood?

A

= due to LV wall damage, LV has reduced ability to pump or eject blood

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6
Q

what are some possible causes of heart failure?

A
  • coronary heart disease
  • hypertension/diabetes
  • dilated cardiomyopathy
  • valve disease
  • tachycardia arrhythmias
  • heart failure with preserved ejection fraction, HFpEF
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7
Q

what are the symptoms of heart failure?

A
  • shortness of breath
  • difficult of breathing at night when recumbent;
    = orthopnoea
    = paroxysmal nocturnal dyspnoea
  • reduced exercise tolerance
  • fatigue / tiredness
  • ankle swelling
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8
Q

in a volume overload scenario in heart failure, what common findings would you find in a physical examination?

A

1) neck exam
= elevated jugular venous pressure

2) auscultation of lungs
= rales or crackles

3) auscultation of heart
= 3rd or 4th heart sounds sometimes called gallop rhythm
= murmur

4) oedema in dependent areas
= sacrum
= feet/ankles/lower legs

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9
Q

what 2 diagnostic tests can be used to diagnose heart failure?
and what can these tests determine?

A

1) ECG
- can identify causes of HF such as;
= arrhythmias
= post MI
= left ventricular hypertrophy

2) chest X-ray
= size & shape of cardiac silhouette
= evidence of fluid accumulation in lungs

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10
Q

what is the single most useful diagnostic test?

A

= trans-thoracic echo-cardiography(TTE)

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11
Q

what does an echocardiogram reveal?

A
  • chamber size
  • right & left ventricular function
  • regional wall motion abnormalities
  • evidence of impaired LV filling (feature of diastolic dysfunction)
  • valvular heart disease
  • diseases of pericardium
  • ejection fraction
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12
Q

what does EF represent?

and what is a normal EF?

A

= % of blood that is pumped out of hart during each beat

= > 50%

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13
Q

what is heart failure with an EF < 40% known as?

A

= heart failure with reduced ejection fraction (HFrEF)

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14
Q

what is heart failure with a normal EF known as?

A

= heart failure with preserved ejection fraction (HFpEF)

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15
Q

what is the difference between HFrEF and HFpEF?

A

HFrEF (reduced)
= LV is unable to eject an adequate amount of blood during systole

HFpEF (preserved)
= less blood is able to fill LV in diastole, due to myocardial stiffness.
= so, LV has less blood to eject during systole

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16
Q

why is echocardiogram the gold standard?

A

for looking at;

1) structure & function
2) LVEF
- systolic dysfunction
- diastolic dysfunction (TDI)
3) may help define cause; valve, previous AMI

17
Q

what is BNP?

if ANP is an atrial hormone, what is BNP?

A

B-type natriuretic peptide which is a cardiac hormone

BNP = ventricular hormone

18
Q

what is the normal range for BNP?

A

= Less than 125 pg/mL for patients aged 0-74 years

= Less than 450 pg/mL for patients aged 75-99 years.

19
Q

what lifestyle measures should you do to avoid heart failure?

A

1) water salt restriction
2) continued exercise
3) vaccinations up to date
4) management of mental health

20
Q

what drugs prolong survival in heart failure?

A

1) RAS inhibitors
= ACE inhibitors & ARI antagonists
= push to maximum dose tolerated

2) B-blockers

3) aldosterone antagonists
e. g. spironolactone & eplerennone

4) vasodilators
e. g. hydralazine & nitrates combined (for this who can’t tolerated ACEI/ARB)

5) sinus node blocker
e. g. ivabradine

21
Q

what drugs improve symptoms in heart failure?

A

e.g.
digoxin
frusemide

22
Q

what is the first line treatment in people with LVSD (left ventricular systolic dysfunction?

A

= ACE inhibitors and beta-blockers licensed for heart failure to all patients with LVSD

= offer beta-blockers licensed for heart failure to all patients with LVSD, including; 
- older adults
- patients with 
= peripheral vascular disease
= erectile dysfunction
= diabetes mellitus 
= interstitial pulmonary disease
= COPD without reversibility
23
Q

what is cardiac resynchronisation therapy (CRT)?

A

it co-ordinates the function of the left and right ventricles.

24
Q

what does the presence of LBBB in heart failure cause?

A

causes

  • abnormal contractile waves frown across the LV
  • LV doesn’t contract efficiently = dysnchronous contraction
  • worsening LV systolic dysfunction
25
Q

what does pacing the LV from left lateral wall do?

A

= increases synchronous contraction

= improves LV haemodynamics

26
Q

what are 3 new treatments for heart failure?

A

1) eplerenone in mild heart failure
2) ivabradine addition when beta-blockers aren’t enough
3) LCZ-696. Pradigm

27
Q

what is ivabradine?

A

If channel modulator

28
Q

what does ivabradine do?

A

= specifically binds the funny channel;

  • slowing heart rate
  • doesn’t work in AF

= doesn’t alter;

  • ventricular depolarisation
  • myocardial contractility
  • blood pressure
29
Q

describe the doses of entresto that should be given?

A
  • Entresto 24 mg/26 mg TWICE DAILY (for ACEI naïve patients or those on low dose ACEI (ramipril 2.5 mg) /ARB (losartan 50 mg)
  • Entresto 49 mg/51 mg TWICE DAILY (from high dose ACEI (Ramipril 10 mg) or ARB (losartan 150 mg)
  • Target dose Entresto 97 mg/103 mg TWICE DAILY
30
Q

what 3 things do you need to be wary of in risk management?

A

1) BP;
- startin BP (SBP > 100mmHg)
- symptomatic hypotension (adjust other medications or temporary down titration)

2) hyperkalaemia
3) renal dysfunction

31
Q

what things should you manage in HfpEF?

A

1) AF.
- Loss of atrial contraction reduce left atrial
emptying

2) Tachycardia.
- Shortens the duration of diastole

3) Elevations in BP (abrupt, severe,
refractory)

4) Ischaemia.
- Acute induction or worsening of diastolic dysfunction by ischemia raises left atrial and therefore pulmonary venous pressure.

32
Q

how would you manage refractory end-stage HF?

A
  • Review etiology, treatment & aggrav. factors”
  • Control fluid retention”
    • Resistance to diuretics”
    • Ultrafiltration ?”
  • iiv inotropics / vasodilators during decompensation”
  • Consider resynchronization”
  • Consider mechanical assist devices”
  • Consider heart transplantation”
33
Q

who are potential candidates for LVAD, from bridge to destination therapy?

A
  • not currently Tx eligible
  • no end stage kidney disease, liver disease or lung disease
  • chronic refractory HF & life expectancy <2years without LVAD
34
Q

who is eligible for heart transplant?

A
  • Refractory cardiogenic shock”
  • Documented dependence on IV inotropic support
    to maintain adequate organ perfusion”
  • Peak VO2 < 10 ml / kg / min “
  • Severe symptoms of ischemia not amenable to revascularization”
  • Recurrent symptomatic ventricular arrhythmias refractory to all therapeutic modalities”

= Contraindications: age, severe comorbidity”

Cardiovascular (Annie) (36 decks)

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