Heart Failure Flashcards
d: heart failure
the state in which the heart cannot pump efficiently
Name the causes of HF in UK
Coronary Heart disease +/- MI Hypertension dilated cardiomyopathy -patients with no obvs causes family history important valve disease tachycardic arrythmias HEFpEF
Name the most common valve diseases in the elderly?
aortic stenosis
What is the SAS response?
Phone the nearest PCI centre (Dundee) Relayed ECG Activates a PPCI Team Immediate treatment GTN s/l Aspirin 300mg oral Clopidogrel 600 mg Heparin 5000 U iv Oxygen via mask Rapid transport to the activated PCI centre Go straight to the cath lab
How is the patient managed in CCU?
Phone the nearest PCI centre (Dundee) Relayed ECG Activates a PPCI Team Immediate treatment GTN s/l Aspirin 300mg oral Clopidogrel 600 mg Heparin 5000 U iv Oxygen via mask Rapid transport to the activated PCI centre Go straight to the cath lab
What are the Classic symptoms of HF?
Shortness of breath Difficulty breathing at night when recumbent Orthopnoea Paroxysmal nocturnal dyspnoea Reduced exercise tolerance Fatigue Tiredness Ankle swelling
What are common Left sided diseases leading to heart failure?
IHD : MIs cardiomyopathy
valvular disease
What are right sided heart diseases that are secondary to left heart failure?
cor pulmonale
congenital heart disease
if you have HF what will your pulse do and what is this called?
Pulsas Alternans (pulse will alternate weak and strong beats)
can you have a combination of left and right heart failure?
yes
symptoms of LVF?
Dyspnoea on exertion/rest, orthopnoea, Paroxysmal Nocturnal Dyspnoea, Pulmonary oedema
clinical signs of LVF?
tachycardia, fine crepitation, pleural effusion, 3rd heart sound
CXR of LVF?
cardiomegaly, bat wings, interstitial fluid
common symptom of RVF?
oedema
clinical signs of RVF?
oedema (ankle/sacral), JVP elevated, hepatomegaly, Ascites
what will the CXR show for RVF?
nothing it will be normal
HF is aka
congestive cardiac failure CCF
Causes of CCF?
Previous MI, Cardiomyopathies.
Cor pulmonale – diuretics + oxygen,
Valvular disease – surgery,
Fast AF – Digoxin or DC Shock.
Name the standard treatment for CCF? HOW DELIVERED?
Diuretics (loop to relieve symptoms [increase dose OR add spironolactone])
2. ACEi (1st line with B-Blocker if LVF, replace with ARB if cough)
3. B-Blockers (calso Ivabradine (only if HR too fast despite B-Blockers)
4. Spironolactone (if symptomatic despite optimum therapy)
5. Digoxin
6. Other Vasodilators (nitrates + hydralazine IF intolerant to ACEi + ARBs)
Implantable Cardiac Defibrillators
Cardiac resynchronisation therapy
Transplantation
what is the std treatment for acute HF?
- Treat any arrhythmias
- Diamorphine IV
- IV furosemide
- GTN
why is the patient given diuretics?
to excrete retained fluid
if the patient has refractory oedema what do you give them instead of diuretics and why?
oedema resistant to diuretics] add thiazide
when is the patient given ivabradine?
only if HR too fast despite B-Blockers
what is a side effect of spironolactone?
gynocomastia
What is digoxin only good for? ans what isnt it good for?
only good for AF, not for CCF in sinus
When is cardiac resynchronisation therapy allowed?
only for prolonged qrs
