Heart Failure Flashcards
What are some causes of acute heart failure?
Can occur with MI
Valvular collapse
What are some causes of chronic heart failure?
More gradual onset so things like:
mitral stenosis, raised pulmonary pressure causing Right heart failure, chronic ischaemia
What symptoms/signs are seen with left heart failure?
Exertional dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea
What symptoms/signs are seen with right heart failure?
Hepatomegaly, splenomegaly, ascites, peripheral oedema
What is seen in congestive cardiac failure?
Signs of hypervolaemia such as peripheral oedema
Briefly describe the pathophysiology behind low output heart failure.
Cardiac output is reduced and fails to increase on exertion. This can be due to pump failure, reduced heart rate (i.e. from beta-blockers), excessive preload (mitral regurg), fluid overload, excessive afterload (i.e. from aortic stenosis or hypertension)
What is sort of cough is characteristic of someone with heart failure?
Nocturnal cough +/- pink frothy sputum
What are the symptoms of heart failure?
Exertional breathlessness, orthopnoea, PND, fatigue, nocturnal cough +/- pink frothy sputum, weight loss +/- muscle wasting, cold peripheries, nocturia
What are some signs of heart failure?
Cardiomegaly, 3rd and 4th heart sounds, elevated JVP, tachycardia, hyper/hypotension, bi-basal crackles, pleural effusion, ankle oedema, ascites.
In which sided heart failure would you expect to see more systemic symptoms due to a back pressure in the venous system?
Right sided heart failure
In which sided heart failure would you expect to see more chest symptoms due to insufficient pumping of blood to the body?
Left sided heart failure
What classification system exists for severity of heart failure and how many classes are there
New York Heart Association Classification of Heart Failure. 4 classes. Class I (no limitation) to Class IV (symptoms at rest)
What is blood test is key to order in suspected heart failure?
N-terminal pro-B-type natriuretic peptide (NT-proBNP)
Normal BNP < 100. If BNP > 400, heart failure is very likely and an urgent referral to cardiology should be made
What investigations should be ordered if heart failure is suspected?
ECG, CXR, BNP.
If abnormal results, do an Echocardiogram.
What changes might be seen on a CXR of someone with heart failure?
A - Alveolar bat wings B - Kerley B lines (interstitial oedema) C - Cardiomegaly D - Dilated prominent upper lobe vessels E - Plueral effusions, pulm. cogestion, loss of costophrenic angles
What is the first line management for someone with heart failure?
Lifestyle advice
ACE-inhibitor (or ARB if intolerant) PLUS beta-blocker
What are some adjuncts that may be used in certain patient groups for the management of heart failure?
Diuretics (e.g. furosemide) Aldosterone antagonsists (e.g. spironolactone) Hydralazine and isosorbide nitrate Digoxin Ivabradine Vasopressin antagonist (e.g. Tolvaptan)
Which calcium channel blocker can be used in HF and which ones should be avoided?
Can be used - Amlodipine
Avoid - diltiazem, verapamil
Which patient group might benefit from the addition of loop diuretics in the management of their HF?
All patients with evidence of fluid retention
Which patient group might benefit from the addition of an aldosterone antagonist (e.g. spironolactone) in the management of their HF?
Patients with New York Heart Association class II to IV heart failure who have left ventricular ejection fraction (LVEF) < 35%
Which patient group might benefit from the addition of digoxin in the management of their HF?
Patients with reduced LVEF, especially those with Atrial Fibrillation.
What things should be assessed/covered during each 6-monthly review for patients with HF?
Assess fluid status, functional capacity, cardiac rhythm, cognitive status, nutritional status.
Review medication and side effects.
Monitor renal function (U+Es, creatinine, eGFR).
Annually - pneumococcal and influenza vaccine, depression screening.
