Heart Failure Flashcards

1
Q

define heart failure

A

a state where the heart is unable to pump blood to adequately perfuse the tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

two types of heart failure

A
  • impaired ejection fraction and left ventricular contraction
  • inability to relax and diastolic dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

presentation of heart failure

A
  • orthopnoea or paroxysmal nocturnal dyspnoea
  • reduced exercise tolerance
  • fatigue
  • pink frothy sputum (pulmonary oedema)
  • right sided = ankle oedema
  • left sided = pulmonary oedema (crepitations)
  • pulsus alternans
  • 3rd and 4th HS
  • JVP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

diagnosis of heart failure

A
  • NYHA functional classification
  • Framingham criteria
  • volume overload on examination e.g. elevated JVP, oedema (CXR) and murmur
  • ECG for cause
  • echocardiogram (GOLD standard)
  • angiogram
  • MRI if alternative diagnosis or infiltrative process suspected
  • CPEX (transplant workup)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

long-term management

A
  • lifestyle
  • ACEI/ARB (first line)
  • beta blockers e.g. bisoprolol or carvedilol
  • dobutamine (less tachycardia)
  • nitrates (vasodilators)
  • diuretics
  • LVAD or ICD
  • transplant if cardiogenic shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

another name for diastolic heart failure

A

HFpEF (heart failure with preserved ejection fraction)

usually >50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

normal ejection fraction

A

more than 50%-70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

classification of ejection fraction in HF

A
borderline= 40-49%
HF= <40%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what does it mean if EF is >75%?

A

HOCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how is ejection fraction measured?

A

echocardiogram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

normal BNP

A

<400

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

causes of heart failure

A
valve dysfunction
MI
arrhythmias
myopathies
hypertension
infection
alcohol
infiltration
metabolic (phaeochromocytoma, thyroid, anorexia)
genetics
cocaine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is pulsus alternans?

A

high volume then low volume pulse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

presentation of LV failure

A
dyspnoea
poor exercise tolerance
fatigue
orthopnoea
PND
pink frothy sputum (pulmonary oedema)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

presentation of RV failure

A

peripheral oedema
ascites
nausea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

immediate management of suspected HF

A

sit patient up
oxygen
IV diuretics (furosemide)
morphine

17
Q

management of HF if good BP

A

IV nitrates
CPAP
BiPAP
IPPV

18
Q

management of HF if bad BP

A

inotropes
CPAP
IABP
LVAD

19
Q

why is BNP a good test?

A

high negative predictive value

20
Q

lifestyle management

A

smoking
diet (salt, weight loss alcohol)
fluid restriction if overload)
cardiac rehab/ HF nurses

21
Q

medication

A
loop diuretics
beta blockers
ACEI/ARBs
MRAs
IV iron therapy
thiazides
digoxin
22
Q

advanced medications

A

entresto(sacubitril/valsartan)

SGLT2i

23
Q

device management

A

ICD and CRT +/- D

ECMO and VAD to bridge to transplant

24
Q

what are CRT?

A

cardiac resynchronisation therapy +/- D (debrillator) or P (pacemaker)