Heart failure Flashcards
What are the causes of heart failure?
IHD, hypertension, Valvular heart disease, AF, Chronic lung disease, cardiomyopathy, previous cancer chemo drugs, HIV
How will people with heart failure present?
Severe fluid overload, high NT-proBNP levels, severe renal impairment, advanced age, multi-morbidity and frequent admissions
What investigations would be done for someone with heart failure?
Renal function for baseline and diuretic effects FBC (anaemia due to bone marrow issue) LFTs hepatic congestions, TFTs thyroid disease, Ferritin and transferrin, NT-proBNP is important as if levels are low then may rule out acute heart failure, high levels do not confirm though, CXR
What will the CXR show in heart failure?
Cardiomeglay, pleural effusions, perihilar shadowing and consolidations, alveolar oedema, air bronco grams, increased with of vascular pedicle
What will an echocardiography look for?
dilated poorly contracting ventricles (systolic dysfunction) or stiff poorly relaxing small diameter left ventricle (diastolic dysfunction, valvular disease, atrial myxoma and pericardial disease
What may a cardiac MRI show that an ECHO may not?
ECHO may miss the right ventricle, scar estimation
What lifestyle modification can be done for someone with heart failure?
Smoking cessation, reduce alcohol, salt restriction, fluid restriction
What medications can be given in heart failure?
Diuretics, ACEi, ARBs ARNIs, Beta blockers, vasodilators, ivabradine and nitrates
Why are diuretics given in heart failure?
most effective symptomatic treatment, loop diuretics e.g. Furosemide can be given IV, should have kidneys checked
Why are ACEi or ARBs given in heart failure?
useful if also hypertensive but also improve symptoms and signs, improve exercise tolerance, slows disease progression and survival
Why are vasodilators given in Heart failure?
beneficial effect on survival if cant take ACEi or ARBs e.e.g hydralazine and isosorbide mononitrate
When is Ivabradine given in heart failure?
if cannot take beta blockers or if patients resting heart rate is still above 75
What do nitrates do in heart failure?
reduce preload, reduce pulmonary oedema and reduce ventricular size, relief of orthopnoea and external dyspnoea
What are some complex device therapies?
cardiac resynchronisation pacemaker (LBBB) or implantable cardiac defibrillators (prevent sudden cardiac death
