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Cardiology > Heart Failure > Flashcards

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?

A

True

25
Q

Patients with HF-PEF should be treated with what kind of drugs to decrease hospitalisations?

A

Aldosterone antagonists

26
Q

What are the signs and. symptoms of hypo perfusion in heart failure?

A 
Cold sweated extremeties
Oliguria
Mental confusion
Dizziness
Narrow pulse pressure
27
Q

What are the signs and symptoms fo congestion in heart failure?

A 
Pulmonary congestion
Ortophnoea / PND
Peripheral oedema
Jugular venous dilatation
Congested hepatomegaly
Gut congestion
Ascites
Hepatojugular reflux
28
Q

How would you treat a patient with acute heart failure and cardiogenic shock?

A

Circulatory support via mechanical or pharmacological methods

29
Q

How would you treat a patient with acute heart failure and respiratory shock?

A

Ventilatory support via oxygen, non-invasive positive pressur ventilation or mechanical ventilation

30
Q

How would you treat a patient with ‘dry and warm’ acute heart failure?

A

Adjust oral therapy

31
Q

How would you treat a patient with ‘wet and warm’ acute heart failure?

A

Vasodilator

Diuretic

32
Q

How would you treat a patient with ‘dry and cold’ acute heart failure?

A

Consider fluid challenge

Consider inotropic agent

33
Q

How would you treat a patient with ‘wet and cold’ acute heart failure and systolic bp <90mmHg?

A

Inotropic agent
Consider vasopressor
Diuretic
Consider mechanical circulatory support

34
Q

How would you treat a patient with ‘wet and cold’ acute heart failure and systolic bp >90mmHg?

A

Vasodilators
Diuretics
Consider inotropic agent

35
Q

Describe stage one of congestive heart failure

A

PCWP 13-18mmHg

Redistribution of pulmonary vessels and cardiomegaly

36
Q

Describe stage two of congestive heart failure

A

PCWP 18-25mmHg

Interstitial oedema

37
Q

Describe stage three of congestive heart failure

A

PCWP >25mmHg

Alveolar oedema

38
Q

In heart failure there is cardiomegaly. T/F?

A

True

39
Q

What is the radiological finding which indicates interstitial oedema?

A

Kerley B lines

40
Q

Describe the appearance of Kerley B lines

A

Short white line ~1cm which originate form the chest wall and run horizontally

41
Q

What are the presentation of alveolar oedema on CXR?

A

Cottonwool appearance
Consolidation
Pleural effusion

42
Q

How much fluid must be present in a pleural effusion to show up on PA CXR?

A

> 175ml

43
Q

A loss of the costophrenic angle with instead a curvilinear upper border on CXR is an indication of…?

A

Pleural effusion

Cardiology (8 decks)

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