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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
How are heart failures with reduced ejection fraction and preserved ejection fraction otherwise known?
PEF - diastolic HF | REF - systolic HF

Year 4 CCC (17 decks)

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