Heart failure Flashcards
What are the two reasons that patients get left sided (chronic) heart failure?
Impaired left ventricular contraction (systolic HF).
Impaired left ventricular relaxation (Diastolic HF).
What causes impaired left ventricular contraction?
LV wall damage, reducing blood volume that can be pumped.
What happens due to impaired relaxation of the LV?
Not enough filling of blood in the cavity.
What is ejection fraction? What is the normal value?
It is the percentage of blood that is pumped out of the left ventricle per HB.
Normal is >50%.
HF with <40% ejection fraction is called what?
Heart failure with reduced ejection fraction.
HFrEF
HF with a normal EF is called what?
Heart failure with preserved ejection fraction
HFpRF
What investigations might be done for diagnosis?
CxR - accumulation of fluid in the lungs.
ECG - arrhythmias, left ventricular hypertrophy
BNP blood test.
What are the symptoms of HF?
PEACO Paroxysmal nocturnal dyspnoea (PND) Elevated JVP. Ankle swelling. Cough - white/pink sputum. Orthopnea - shortness of breath when lying flat relieved when standing up.
What is PND?
Patient wakes up in the middle of the night breathless and cough.
What treatment is given for HF?
ABAL VD ACE inhibitor - ramapril B blocker - bisoprolol aldosterone inhibitor - spironolactone/eplerenone Loop diuretic - furosemide
Vasodilator - nitrates
Digoxin - for relieving symptoms
Top three most important, remember to give ARB if ACE not working.
What two drugs are given first?
ACE inhibitor and B blocker.
What diseases cause HF?
CHAV Coronary HD (stable angina). Hypertension. Arrhythmias. Valve disease.
Why might a patient be short of breath when lying flat if they have heart failure?
The fluid at the base of the lungs due to the heart failure will be spread across the lungs when lying flat leading to shortness of breath.
What are some of the causes of heart failure?
Coronary HD.
Hypertension.
Valve disease.
Arrhythmias.
