Heart Failure Flashcards
define heart failure
a state where the heart is unable to pump blood to adequately perfuse the tissues
two types of heart failure
- impaired ejection fraction and left ventricular contraction
- inability to relax and diastolic dysfunction
presentation of heart failure
- 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
diagnosis of heart failure
- 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)
long-term management
- 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
another name for diastolic heart failure
HFpEF (heart failure with preserved ejection fraction)
usually >50%
normal ejection fraction
more than 50%-70%
classification of ejection fraction in HF
borderline= 40-49% HF= <40%
what does it mean if EF is >75%?
HOCM
how is ejection fraction measured?
echocardiogram
normal BNP
<400
causes of heart failure
valve dysfunction MI arrhythmias myopathies hypertension infection alcohol infiltration metabolic (phaeochromocytoma, thyroid, anorexia) genetics cocaine
what is pulsus alternans?
high volume then low volume pulse
presentation of LV failure
dyspnoea poor exercise tolerance fatigue orthopnoea PND pink frothy sputum (pulmonary oedema)
presentation of RV failure
peripheral oedema
ascites
nausea
immediate management of suspected HF
sit patient up
oxygen
IV diuretics (furosemide)
morphine
management of HF if good BP
IV nitrates
CPAP
BiPAP
IPPV
management of HF if bad BP
inotropes
CPAP
IABP
LVAD
why is BNP a good test?
high negative predictive value
lifestyle management
smoking
diet (salt, weight loss alcohol)
fluid restriction if overload)
cardiac rehab/ HF nurses
medication
loop diuretics beta blockers ACEI/ARBs MRAs IV iron therapy thiazides digoxin
advanced medications
entresto(sacubitril/valsartan)
SGLT2i
device management
ICD and CRT +/- D
ECMO and VAD to bridge to transplant
what are CRT?
cardiac resynchronisation therapy +/- D (debrillator) or P (pacemaker)
