Heart Failure Flashcards
What is heart failure?
Failure of the heart to pump blood at a sufficient. rate to meet the metabolic requirements of the tissues
What are the typical haemodynamic changes seen in heart failure?
Systemic vasoconstriction
Neurohumoral activation
Heart failure is associated with frequent hospitalisations and poor survival. T/F?
True
How many people in the population does heart failure affect?
1-2%
What are some of the common causes of heart failure (for UK patients)?
Coronary artery disease / MI Hypertension Idioapthic Toxins (alcohol, chemotherapy) Genetic
What are some of the less common causes of heart failure (for UK patients)?
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
What sub-type of heart failure is seen more often in older, female. patients with a hypertensive aetiology?
HF-PEF
What are the symptoms fo heart failure?
Dyspnoea - orthopnoea, PND, cough
Ankle swelling
Fatigue
What are the clinical signs of heart failure?
Peripheral oedema Elevated JVP Third heart sound Displaced apex beat (cardiomegaly) Pulmonary oedema (lung crackles) Pleural. effusion
Describe stage one of the New York heart association functional classification of heart failure.
No symptoms and no limitation in ordinary physical activity
Describe stage two of the New York heart association functional classification of heart failure.
Mild symptoms (mild dyspnoea and/or angina) and slight limitation during ordinary activity
Describe stage three of the New York heart association functional classification of heart failure.
Marked limitation in a activity due to symptoms even during less than ordinary activity such as walking short distances. Comfortable only at rest.
Describe stage four of the New York heart association functional classification of heart failure.
Severe limitations
Experiences symptoms even while at rest
Mostly. bed bound
What investigations should be conducted in all patients with potential heart failure?
ECG CXR Echocardiogram Blood chemistry - U&Es, Cr, urea, LFTs, urate Haematology Natriuretic peptides
In addition to the standard investigations of heart failure, what additional tests might you run in selected patients?
Coronary angiography Exercis test Ambulatory ECG Myocardial biopsy Genetic testing
Signs and symptoms of heart failure alongside the presence of what proteins in the blood incite heart failure?
Naturietic peptides - BNP
What is the first line treatment fo HF-REF?
Beta blockers and ACE inhibitor
What is the second line treatment of HF-REF?
Mineralocorticoid. receptor antagonist added
In the third line treatment of HF-REF, an ACE inhibitor is stopped and replaced with…?
Sacubitril and valsartan
Diuretics improve the outcomes of patients with heart failure. T/F?
False - they only provide symptomatic management
What is the fourth line therapy of heart failure?
Devices such as implantable cardioverter defibrillator and cardiac resynchronisation therapy
Of all other treatments fail, what management option should be considered for patients with heart failure?
Heart transplant
Why is sacubitril given alonside an ARB rather than an ACE inhibitor in the treatment of heart failure?
Sacubitril and ACE inhibitors both exhibit an effect on bradykinin and if given in conjuction would cause angiooedema
There is little guidance on the treatment of HF-PEF. T/F?
True
Patients with HF-PEF should be treated with what kind of drugs to decrease hospitalisations?
Aldosterone antagonists
What are the signs and. symptoms of hypo perfusion in heart failure?
Cold sweated extremeties Oliguria Mental confusion Dizziness Narrow pulse pressure
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
How would you treat a patient with acute heart failure and cardiogenic shock?
Circulatory support via mechanical or pharmacological methods
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
How would you treat a patient with ‘dry and warm’ acute heart failure?
Adjust oral therapy
How would you treat a patient with ‘wet and warm’ acute heart failure?
Vasodilator
Diuretic
How would you treat a patient with ‘dry and cold’ acute heart failure?
Consider fluid challenge
Consider inotropic agent
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
How would you treat a patient with ‘wet and cold’ acute heart failure and systolic bp >90mmHg?
Vasodilators
Diuretics
Consider inotropic agent
Describe stage one of congestive heart failure
PCWP 13-18mmHg
Redistribution of pulmonary vessels and cardiomegaly
Describe stage two of congestive heart failure
PCWP 18-25mmHg
Interstitial oedema
Describe stage three of congestive heart failure
PCWP >25mmHg
Alveolar oedema
In heart failure there is cardiomegaly. T/F?
True
What is the radiological finding which indicates interstitial oedema?
Kerley B lines
Describe the appearance of Kerley B lines
Short white line ~1cm which originate form the chest wall and run horizontally
What are the presentation of alveolar oedema on CXR?
Cottonwool appearance
Consolidation
Pleural effusion
How much fluid must be present in a pleural effusion to show up on PA CXR?
> 175ml
A loss of the costophrenic angle with instead a curvilinear upper border on CXR is an indication of…?
Pleural effusion
