heart failure Flashcards
what is the definition of heart failure
clinical syndrome
dyspnoea, fatigue or fluid retention due to cardiac dysfunction
when can heart failure occur
at rest or on exertion
what is heart failure due to
LVSD or IHD
left ventricle systolic dysfunction or ischemic heart disease
sever aortic stenosis
what is the prognosis of heart failure
30-40% mortality at 1 year
what is the general epidemiology of heart failure
affects 1-2% of uk population
increasing in prevalence
what are the symptoms of heart failure
dyspnoea
fatigue
oedema
what are the sings of heart failure
oedema tachycardia raised JVP 3rd heart sound displaced apex beat
how is heart failure diagnosed
sings and symptoms
and
objective evidence
what are the diagnostic techniques for heart failure
ECHO
cardiac MRI
radionucleotide scan
ECG? (RARLEY SEEN)
what are the pharmacological treatments for heart failure
diuretics - MAIN ONE
ACE inhibitors
beta blockers
ARNIs (get to the choppa!!!)
what do diuretics do
produce more urine
what are the effects of heart failure on LVEV and Co
Co might not be lower
LVEF may be lower but not pathologically low
what must you do after determining it to be heart failure
dig deeper and get to the root of the cause of the syndrome
what can cause heart failure (aetiology)
fibrosis
infiltrate
oedema
what is chronic HF syndrome characterised by
progressive cardiac dysfunction
SOB
fatigue
neurohormonal disturbances
what are the two types of heart failure `
systolic - decreased pump function
diastolic - thickening/ stiffened heart
what drugs improve Heart failure symptoms
diuretics
digoxin
what drugs improve survival of heart failure
beta blockers
ivabradine
what drugs improve both survival and symptoms of heart failure
ACE inhibitors
how do beta blockers improve survival
by stopping sympathetic action and stopping the increased strain on the heart
how does the sympathetic stimulation lead to further heart failure
the Renin-angiotensin-aldosterone system produced vasoconstriction and salt/water retention
leading to greater pre load and afterload
meaning more work (more volume) and less output (increased afterload)
what is digoxin
a positive inotrope
what does a positive ionotropes do
improve the ability of the heart to pump and so improve cardiac status
what is the mainstay of heart failure
loop diuretics
furosemide
what is the problem with loop diuretics
cause problems with renal system meaning renal failure to stop cardia failure
what does ace inhibitors do in heart failure
reduce morbidity and mortality
what is the problem with beta blockers in chronic heart failure
if the patient is not stable they can die as there HR gets slowed down
DONT USE ON ACCUTE PRESENTATION
how does digoxin work - any problems
increases the availability for calcium to the myocytes
narrow therapeutic index
arrhythmias
what is a rough therapeutic regime for someone with heart failure
diuretics
ACE inhibitors
beta blocker
digoxin
warfarin
what is warfarin
antiplatelet medications
why use warfarin
Dilated ventricle gives rise to thrombus formation and thrombo-embolic events - warfarin prevents this
what is the problems with ACH inhibitors
can cause renal failure
