Heart failure Flashcards
It is the end stage of ______
All heart diseases
Definition of HF
Ability of the heart to maintain circulation is impaired due to a structural or functional impairment of ventricular filling or ejection
what are the two categories of HF?
Preserved and reduced ejection fraction
What is reduced ejection fraction HF?
<40%
Systolic dysfunction
What is preserved ejection fraction HF?
50-70%
Preserved systolic function
Clinical signs but LV and valves are normal
Classification used for HF
New york
most common underlying cause
CAD
5ys rate
about 50%
Risk factors
HTN, DM, AF, MI, angina
FHx
Drugs and alcohol
chemo in past
Investigation depends on what?
Prev MI or not
Investigation specifically if in no previous MI?
Measure BNP:
> 400- 2w referral to cardiology and echo
100-400- 6w referral
<100- HF unlikely
Investigation specifically if previous MI
Refer straight to cardiology and echo
Investigations to be done in all?
12L ECG
CXR
Bloods (U+E, Cr, FBC, TFT, LFT, HbA1c, lipids)
Urinalysis (for blood and protein- if they have CKD as well v bad)
Lung function (peak flow or spiro)
What might ECG show
Left axis deviation
LVH (V1 tall R wave, V6 deep S wave)
Previous MI (thick Q wave, inverted T wave, ST depression)
What symptom control can you give while awaiting test results?
Loop diuretic
Furosemide 20-40mg
Also review medication
How reliable is BNP?
It can be raised or lowered by other things
What can BNP be reduced by?
High BMI
Some drugs (diuretic, ACEi, ARB, beta blocker, aldosterone antagonists e.g. spironolactone)
What can BNP be elevated by?
> 70y
Female
LVH
Myocardial ischaemia
Tachycardia
Hypoxia
Pulmonary HTN
PE
CKD
Sepsis
COPD
DM
Liver cirrhosis
Why are NSAIDs bad in HF?
Increase fluid retention and nephrotoxic
Why should CCBs be avoided in HF due to systolic dysfunction?
negative inotropic effects may exacerbate the disease.
management of reduced ejection fraction HF
- Review drugs that may cause or worsen
- Loop diuretic
- ACEi (or ARB) (titrate to maximum tolerated dose)
- beta blocker (bisoprolol) (titrate to maximum tolerated dose)
- Consider:
- Antiplatelet if atherosclerosis
- Statin
How do ACEi help HF
Reduce preload and reduce SVR for easier after load
How do beta blockers help?
Make heart beat slower- so protective against chronic sympathetic stimulation
Do you start the ACEi and beta blocker at the same time?
No
What other things can you consider for broader management?
- Manage causes/comorbidities
- Depression screen
- Group exercise rehab referral
- ACP
- Nutrition
Management for preserved ejection fraction HF?
- Review meds
- Loop diuretic (up to 80mg furosemide)
- Refer
- Consider antiplatelet or statin
Do people with HF get extra vaccines?
Flu and pneumococcal
What exercise is recommended in HF?
Regular low intesity
What should a heart failure review include?
- Symptom check
- Updated NHYA classification
- Pulse rate and rhythm (–> ecg if abnormal or if syncope symptoms, or symptoms deteriorated)
- Fluid status (weight (and do BMI), listen to chest, oedema, hepatomegaly, postural drop in BP, JVP)
- Function, cognition, psychosocial needs, nutritional status, depression screen
- Review meds, up to date vaccines
- Bloods- U+Es, eGFR, creatinine, HbA1c, lipids
How often should you review them
6months
What advice can you give hf patients about managing their condition (8)
- Recognising symptoms and when to seek help
- Monitor body weight
- Keep active
- Smoking and alcohol
- Restrict salt consumption (just avoid excess, no specific guidance)
- Avoid excessive fluid intake
- Symptoms of dehydration
- Vaccines
What are the driving rules for heart failure?
Continue as long as no symptoms distract, don’t need to inform DVLA
Lorries- disqualified if symptomatic (may be relicensed following tests)
Check with insurer that still covered
