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Year 4 CCC > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is measured in people with suspected heart failure?

A

N-terminal pro-B-type natriuretic peptide (NT-proBNP)

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2
Q

What level of NT-proBNP would result in urgent referral to have specialist assessment within 2 weeks?

A

2000ng/litre (236pmol/litre)

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3
Q

Which investigation is carried out in someone with suspected heart failure who has a high NT-proBNP?

A

Transthoracic echocardiography

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4
Q

A level below what of NT-proBNP would make a diagnosis of heart failure very unlikely?

A

400ng/litre (47pmol/litre)

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5
Q

In someone with an NT-proBNP of between 400ng-2000ng/litre, within how long do they have to be seen by?

A

6 weeks

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6
Q

What are the myocardial diseases that can lead to heart failure? (3)

A
  1. Coronary artery disease (most common)
  2. Hypertension
  3. Cardiomyopathies (familial, infective, immune-mediated, toxins, pregnancy)
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7
Q

What are the high output states that can leads to heart failure? (7)

A
  1. Anaemia
  2. Thyrotoxicosis
  3. Phaechromocytoma
  4. Sepsis
  5. Liver failure
  6. Paget’s disease
  7. Thiamine deficiency (B1)
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8
Q

What are the volume overload states that can lead to heart failure? (2)

A
  1. End-stage CKD

2. Nephrotic syndrome

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9
Q

In addition to the myocardial diseases, high output states and volume overland, what else can cause heart failure? (5)

A
  1. Obesity
  2. Drugs - alcohol, cocaine, NSAIDs
  3. Arrhythmias
  4. Pericardial disease
  5. Valvular heart disease
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10
Q

What is the prognosis for heart failure - what % of people will die with 5 years of diagnosis?

A

50%

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11
Q

What are the complications of heart failure?

A
  1. Atrial fibrillation - most common arrhythmia in people with heart failure (50% of people with severe HF)
  2. Depression
  3. Cachexia (associated with reduced ejection fraction)
  4. CKD
  5. Sexual dysfunction
  6. Sudden cardiac death
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12
Q

What are the typical symptoms of heart failure?

A
  1. Breathlessness
  2. Fluid retention
  3. Fatigue
  4. Dizziness/syncope
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13
Q

What are the different types of breathlessness, important to ask about with heart failure?

A

Is it:

  • On exertion?
  • At rest?
  • Lying flat (orthopnoea)
  • At night/waking from sleep? (paroxysmal nocturnal dyspnoea)
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14
Q

What are the risk factors for developing heart failure? (3)

A
  1. Coronary artery disease (previous MI, hypertension, AF, diabetes)
  2. Drugs/alcohol
  3. FHx (heart failure or sudden cardiac death under 40 years of age) `
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15
Q

What should you look for on examination of someone with suspected heart failure? (8)

A
  1. Tachycardia (<100bpm) and pulse rhythm
  2. Laterally displaced apex beat, heart murmurs, gallop rhythm
  3. Hypertension
  4. Raised JVP
  5. Hepatomegaly
  6. Tachypnoea, basal crepitations, pleural effusions
  7. Oedema/ascites
  8. Oedema
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16
Q

How should someone with suspected heart failure be managed to begin with?

A
  1. Review their medications - if appropriate, stop or reduce any drugs that may worsen heart failure
  2. Start loop diuretic - Furosemide 20-40mg daily
17
Q

Which values of BNP (B-type) and N-terminal pro-BNP would require a referral for specialist assessment within 2 weeks

A 
BNP = >400pg/ml
NT-pro-BNP = >2000pg/ml
18
Q

What about the values for BNP and NT-pro-BNP for assessment within 6 weeks?

A 
BNP = 100-400pg/ml 
NT-pro-BNP = 400-2000pg/ml
19
Q

If someone presents with features of heart failure and they have previously had an MI, what needs to be done?

A

Do not measure BNP as they need to be referred urgently anyway for specialist assessment and echocardiography

20
Q

What investigation needs to be arranged in anyone presenting with suspected heart failure?

A

12-lead ECG

21
Q

In addition to ECG, what other tests should be considered in someone with suspected heart failure?

A
  1. CXR
  2. Bloods - U&Es, eGFR, FBC, TFTs, LFTs, HbA1c
  3. Urine dipstick
  4. Lung function tests (peak flow/spirometry)
22
Q

In someone with clear symptoms of heart failure, why might their BNP measure within the normal range/not be elevated?

A
  1. BMI - greater than 35kg/m2

2. Drugs - diuretics, ACEi, BBs, spironolactone

23
Q

When might BNP levels be raised anyway, even without heart failure? (10)

A
  1. Age over 70 years
  2. Female gender
  3. Left ventricular hypertrophy, MI,
  4. Hypoxia
  5. Pulmonary hypertension
  6. PE
  7. CKD
  8. Sepsis
  9. COPD
  10. Diabetes
24
Q

What are the differentials for heart failure? (6)

A
  1. Conditions causing breathlessness - COPD, asthma, PE, lung cancer, anxiety
  2. Conditions causing peripheral oedema - nephrotic syndrome, drugs (CCBs, NSAIDs), hypoalbuminaemia, pelvic tumour
  3. Obesity
  4. Severe anaemia
  5. Thyroid disease
  6. Bilateral renal artery stenosis
25
Q

How are heart failures with reduced ejection fraction and preserved ejection fraction otherwise known?

A

PEF - diastolic HF

REF - systolic HF

Year 4 CCC (17 decks)

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