Heart Failure Flashcards
Prognostic indicator of heart failure?
Serum natiuretic peptide
Pulsus alternans (poor prognosis)
5 signs on cardiac exam for acute heart failure?
S3 heart sound, Raised JVP, Bibasal crackles Peripheral/central cyanosis, Kussmaul’s sign (JVP up on inspiration), Possibly displaced apex beat (LV hypertrophy), Parasternal heave (due to RV hypertrophy)
3 signs on GI exam for acute heart failure?
Ascites Hepatomegaly Pulsatile liver
5 causes of acute heart failure?
Myocardial infarction Arrhythmia Sepsis Drugs i.e cocaine Anaemia Acute decompensation of chronic heart failure
5 causes of chronic heart failure
Age Mitral regurgitation Aortic stenosis (above 2 cause HFrEF Aortic regurgitation (causes HFpEF) COPD (right sided) Hypertension
Drug and dose of acute heart failure Mx
Sit patient upright High flow O2 IV furosemide (40-80mg slowly) (ultfiltration if fails) –> Offer CPAP if severe acidaemia/dyspnoea –> intubate if decreased consciousness/respiratory failure ACE-i + spironolactone once stabilised –> Consider Haemofiltration if diuretic resistance
1st line Tx for heart failure and how do they work?
ACE-i (reduces afterload) + - ACE-i determines prognosis? B-blockers (increases time for heart to refill)
What classification for severity of Heart Failure?
New York classification of heart failure
Criteria to diagnose heart failure?
Framingham criteria
5 signs of Chest x-ray for heart failure
Alveolar oedema Kerley B lines Cardiomegaly Dilated pulmonary vessels Pleural effusions
Things/Investigations to monitor acute heart failure?
U + Es –> potential disturbance (from furosemide) Weight –> how much water is in Urine output –> how much is out
What are some indicators of people likely to have end-stage heart failure?
Frequent hospital admissions.
Poor response to treatment and severe breathlessness at rest (New York Heart Association class IV).
Presence of cardiac cachexia.
Low serum albumin.
Progressive deterioration in estimated glomerular filtration rate (eGFR) and hypotension limiting the use of drug treatments.
Acute deterioration and increasingly frequent hospital admissions from comorbid conditions (such as a chest infection).
Poor quality of life and dependence on others for most activities of daily living.
People who are clinically judged to be close to the end of life.
What are the B-blockers licensed for use in heart failure in the UK?
Bisoprolol Nebivolol Carvedilol
What is the referral criteria for patients to have a TTE for heart failure? What is the serum BNP cutoff?
What is the Mx flowchart for people with heat failure with reduced ejection fraction?
Spironolactone improves mortality
