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Heart Failure Flashcards

1
Q

What is heart failure?

A

Failure of the heart to pump blood at a sufficient. rate to meet the metabolic requirements of the tissues

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2
Q

What are the typical haemodynamic changes seen in heart failure?

A

Systemic vasoconstriction

Neurohumoral activation

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3
Q

Heart failure is associated with frequent hospitalisations and poor survival. T/F?

A

True

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4
Q

How many people in the population does heart failure affect?

A

1-2%

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5
Q

What are some of the common causes of heart failure (for UK patients)?

A 
Coronary artery disease / MI
Hypertension
Idioapthic
Toxins (alcohol, chemotherapy)
Genetic
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6
Q

What are some of the less common causes of heart failure (for UK patients)?

A 
Valve disease
Infections e.g. virus, Chaga's
Congenital heart disease
Metabolic e.g. haemochomatosis, amyloid, thyroid disease
Pericardial disease e.g. TB
Endocardial disease
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7
Q

What sub-type of heart failure is seen more often in older, female. patients with a hypertensive aetiology?

A

HF-PEF

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8
Q

What are the symptoms fo heart failure?

A

Dyspnoea - orthopnoea, PND, cough
Ankle swelling
Fatigue

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9
Q

What are the clinical signs of heart failure?

A 
Peripheral oedema
Elevated JVP
Third heart sound
Displaced apex beat (cardiomegaly)
Pulmonary oedema (lung crackles)
Pleural. effusion
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10
Q

Describe stage one of the New York heart association functional classification of heart failure.

A

No symptoms and no limitation in ordinary physical activity

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11
Q

Describe stage two of the New York heart association functional classification of heart failure.

A

Mild symptoms (mild dyspnoea and/or angina) and slight limitation during ordinary activity

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12
Q

Describe stage three of the New York heart association functional classification of heart failure.

A

Marked limitation in a activity due to symptoms even during less than ordinary activity such as walking short distances. Comfortable only at rest.

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13
Q

Describe stage four of the New York heart association functional classification of heart failure.

A

Severe limitations
Experiences symptoms even while at rest
Mostly. bed bound

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14
Q

What investigations should be conducted in all patients with potential heart failure?

A 
ECG
CXR
Echocardiogram
Blood chemistry - U&Es, Cr, urea,  LFTs, urate
Haematology 
Natriuretic peptides
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15
Q

In addition to the standard investigations of heart failure, what additional tests might you run in selected patients?

A 
Coronary angiography
Exercis test
Ambulatory ECG
Myocardial biopsy
Genetic testing
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16
Q

Signs and symptoms of heart failure alongside the presence of what proteins in the blood incite heart failure?

A

Naturietic peptides - BNP

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17
Q

What is the first line treatment fo HF-REF?

A

Beta blockers and ACE inhibitor

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18
Q

What is the second line treatment of HF-REF?

A

Mineralocorticoid. receptor antagonist added

19
Q

In the third line treatment of HF-REF, an ACE inhibitor is stopped and replaced with…?

A

Sacubitril and valsartan

20
Q

Diuretics improve the outcomes of patients with heart failure. T/F?

A

False - they only provide symptomatic management

21
Q

What is the fourth line therapy of heart failure?

A

Devices such as implantable cardioverter defibrillator and cardiac resynchronisation therapy

22
Q

Of all other treatments fail, what management option should be considered for patients with heart failure?

A

Heart transplant

23
Q

Why is sacubitril given alonside an ARB rather than an ACE inhibitor in the treatment of heart failure?

A

Sacubitril and ACE inhibitors both exhibit an effect on bradykinin and if given in conjuction would cause angiooedema

24
Q

There is little guidance on the treatment of HF-PEF. T/F?

25
Patients with HF-PEF should be treated with what kind of drugs to decrease hospitalisations?
Aldosterone antagonists
26
What are the signs and. symptoms of hypo perfusion in heart failure?
``` Cold sweated extremeties Oliguria Mental confusion Dizziness Narrow pulse pressure ```
27
What are the signs and symptoms fo congestion in heart failure?
``` Pulmonary congestion Ortophnoea / PND Peripheral oedema Jugular venous dilatation Congested hepatomegaly Gut congestion Ascites Hepatojugular reflux ```
28
How would you treat a patient with acute heart failure and cardiogenic shock?
Circulatory support via mechanical or pharmacological methods
29
How would you treat a patient with acute heart failure and respiratory shock?
Ventilatory support via oxygen, non-invasive positive pressur ventilation or mechanical ventilation
30
How would you treat a patient with 'dry and warm' acute heart failure?
Adjust oral therapy
31
How would you treat a patient with 'wet and warm' acute heart failure?
Vasodilator | Diuretic
32
How would you treat a patient with 'dry and cold' acute heart failure?
Consider fluid challenge | Consider inotropic agent
33
How would you treat a patient with 'wet and cold' acute heart failure and systolic bp <90mmHg?
Inotropic agent Consider vasopressor Diuretic Consider mechanical circulatory support
34
How would you treat a patient with 'wet and cold' acute heart failure and systolic bp >90mmHg?
Vasodilators Diuretics Consider inotropic agent
35
Describe stage one of congestive heart failure
PCWP 13-18mmHg | Redistribution of pulmonary vessels and cardiomegaly
36
Describe stage two of congestive heart failure
PCWP 18-25mmHg | Interstitial oedema
37
Describe stage three of congestive heart failure
PCWP >25mmHg | Alveolar oedema
38
In heart failure there is cardiomegaly. T/F?
True
39
What is the radiological finding which indicates interstitial oedema?
Kerley B lines
40
Describe the appearance of Kerley B lines
Short white line ~1cm which originate form the chest wall and run horizontally
41
What are the presentation of alveolar oedema on CXR?
Cottonwool appearance Consolidation Pleural effusion
42
How much fluid must be present in a pleural effusion to show up on PA CXR?
>175ml
43
A loss of the costophrenic angle with instead a curvilinear upper border on CXR is an indication of...?
Pleural effusion

Cardiology (8 decks)

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