Heart failure Flashcards
What is heart failure - doctor
Heart failure is a condition in which the heart is unable to generate a cardiac output sufficient to meet the demands of the body without increasing diastolic pressure.
What is heart failure - patient
An ongoing condition where over time the heart is unable to pump enough blood around the body to provide oxygen for all the cells and muscles
Risk factors for chronic heart failure
- IHD
- Diabetes
- dyslipidaemia
- old age
- HTN
- FH
- valvular heart disease
- renal insufficiency
- cocaine
Symptoms of HF
- dyspnoea
- chest discomfort
- ankle oedema
- night cough
- orthopnoea
- paroxysmal nocturnal dyspnoea
Signs of HF
- S3 gallop
- neck vein distention
- hepatojugular reflex
- rales
- hepatomegaly
Signs of HF on XRAY
A - alveolar oedema - bat wing B - Kerley B lines C -- cardiomegaly D - dilated upper lobe vessels E - effusion
Investigations for HF
- ECG
- CXR
- Echo
- BNP
- U&Es
- lipids
Which electrolyte imbalance may you see in HF
hyponatraemia
Investigations to consider for HF
standard exercise testing
6 minute walking test
cardiopulmonary exercise testing
NYA Class 1
Mild. No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitations, or dyspnoea.
NYA Class 2
Mild. Slight limitation of physical activity. Comfortable at rest, but ordinary physical activity results in fatigue, palpitations, or dyspnoea.
NYA Class 3
Moderate. Marked limitation of physical activity. Comfortable at rest, but gentle activity causes fatigue, palpitations, or dyspnoea.
NYA Class 4
Unable to carry out any physical activity without discomfort. Symptoms of cardiac insufficiency at rest. If any physical activity is undertaken, discomfort is increased.
What life style changes are recommended in HF
- exercise 30 mins 5/7 symptom limited
- stop smoking/alcohol
- reduce salt intake/fat intake
- fluid restriction
- daily weight monitoring
- lipid management
- yearly pneumococcal vaccine
Pharmacological treatment of HF
- ACEi/ARBs
- beta blocker
- diuretic if overloaded
- aldoesterone antag - spironalactone
- statin
Complications of HF
- pleural effusion
- acute decompensation of HF
- acute renal failure/insufficiency
- sudden cardiac death
- anaemia
Management of acute decompensation of HF
- Furesomide
- Oxygen
- ACEi/ARBs
- nesiritide - vasodilator - if needed
- beta blocker - if needed
Types of acute coronary syndrome
- Unstable angina
- NSTEMI
- STEMI
Unstable angina criteria
- Chest pain not relieved on rest/with nitrates
- Troponin normal
- Normal ECG/transient changes - ST depression
Treatment of confirmed unstable angina
- Aspirin 75mg
- Statin
- Beta blocker
- ACEi
- Cardiac rehabilitation (lifestyle)
What is Paroxysmal nocturnal dyspnoea
Patients will describe waking up and feeling acutely short of breath, with a cough and wheeze. Symptoms improve over several minutes
Causes of chronic HF
Ischaemic Heart Disease
Valvular Heart Disease (commonly aortic stenosis)
Hypertension
Arrhythmias (commonly atrial fibrillation)
When do you start someone on an aldostesterone antagonist in chronic HF
when there is a reduced ejection fraction and symptoms are not controlled with an ACEi and beta blocker.
What should patients on diuretics, ACE inhibitors and aldosterone antagonists be monitored for frequently
electrolyte imbalances
What is cor pulmonale
Right sides heart failure due to the increased pressure and resistance in the pulmonary arteries (pulmonary hypertension) results in the right ventricle being unable to effectively pump blood out of the ventricle and into the pulmonary arteries. This leads to back pressure of blood in the right atrium, the vena cava and the systemic venous system.
What are the main respiratory causes for cor pulmonale
COPD: most common Pulmonary Embolism Interstitial Lung Disease Cystic Fibrosis Primary Pulmonary Hypertension
What are the signs of cor pulmonale
Hypoxia
Cyanosis
Raised JVP
S3
Murmurs (e.g. pan-systolic in tricuspid regurgitation)
Hepatomegaly due to back pressure in the hepatic vein
What is the presentation of someone with cor pulmonale
- Early stages asymptomatic
- SOB: rest or exertion
- peripheral oedema
- syncope
- chest pain
What is the management of cor pulmonale
- Treat underlying cause
- Treat symptoms
- LTOT
- Prognosis is poor unless treatment of underlying acuse
What are the acute signs of right ventricular failure
- Raised JVP
- hepatojugular reflux sign
- Hepatomegaly
What are the chronic signs of right ventricular failure
- Pedal oedema
- Sacral oedema
- Ascites
What are the signs of left ventricular failure
- Pulmonary oedema
- Poor peripheral perfusion
- Tachypnoea
- Tachycardia
What are the acute causes of right ventricular failure
- MI
- PE
- Infective endocarditis
What are the chronic causes of right ventricular failure
- Left ventricular failure
- Cor pulmonale
What are the acute causes of left ventricular failure
- MI
- Infective endocarditis
What are the chronic causes of left ventricular failure
- Ischaemic cardiomyopathy
- Hypertensive cardiomyopathy
- Valvular heart disease
What is the conservative management of congestive cardiac failure
- stop smoking
- Long term O2 therapy if cor pulmoanle
What is the medical management of congestive cardiac failure
- Beta blocker
- ACEi
- Treat underlying causes e.g. HTN, Afib
What is the surgical management of congestive cardiac failure
Left ventricular assist devices or transplant
