Heart Failure Flashcards
What is the definition of heart failure?
Cardiac output is inadequate for body’s requirements
- impaired LV filling
+/- impaired ejection of blood
What is diastolic failure also known as?
HF with preserved ejection fraction
Describe the pathophysiology of diastolic failure
Impaired LV filling:
LV doesn’t relax properly in diastole, so volume of blood is reduced
–> reduced SV
What is the ejection fraction in diastolic failure?
> 50%
What is systolic failure also known as?
HF with reduced ejection fraction
Describe the pathophysiology of systolic failure
Impaired ejection of blood:
due to LV wall damage
–> reduced ability to pump/eject blood
What is the ejection fraction in systolic failure?
< 40%
What are some causes of diastolic failure?
Constrictive pericarditis
Tamponade
Restrictive cardiomyopathy
Hypertension
What are some causes of systolic failure?
IHD
MI
Dilated cardiomyopathy
Describe some classic symptoms of heart failure?
SOB Difficulty breathing when lying flat - orthopnoea - paroxysmal nocturnal dyspnoea (suddenly waking up SOB/coughing) Reduced exercise tolerance Fatigue Tiredness Ankle swelling
What neck examination finding might be suggestive of fluid overload?
Raised JVP
What chest examination findings might suggest fluid overload?
Crackles
What might be found on examination of the heart suggestive of fluid overload?
3rd or 4th heart sound (S3 or S4) –> gallop rhythm
Murmur
Where might you find oedema in a patient with HF?
Lungs –> left heart failure
Peripheries e.g. sacrum, legs –> right heart failure
Which investigations should be done in someone with suspected HF?
ECG
CXR
Echo
BNP
What might be seen on an ECG of a patient with HF?
Arrhythmia
Previous MI
LVH
What are the classic CXR findings in HF?
A - alveolar bat wings B - Kerley B lines (interstitial oedema) C - cardiomegaly (cardiothoracic ratio > 50%) D - dilated prominent upper lobe vessels E - effusion (pleural)
What is the gold standard investigation for diagnosing HF?
Echocardiogram
What is the ejection fraction and what is a normal value?
Percentage of blood pumped out in each beat
Normall >50%
What is BNP and why is it useful to test?
Brain natriuretic peptide - cardiac hormone
Can rule out HF in symptomatic patients
What are some lifestyle measures in the management of HF?
Exercise based rehab
1.5 - 2 litres water per day
Avoid salt
Vaccinations up to date
What are the two main aims of pharmacological management?
Prolong survival
Improve symptoms
Which drugs are given to prolong survival in HF?
ACE inhibitors/ARBs
Beta-blockers
Aldosterone antagonists (spironolactone/eplerenone)
Which drugs can be given in those who cannot tolerate ACE inhibitors?
Vasodilators
–> Hydralazine + nitrates
Which drugs are given to improve symptoms in HF?
Furosemide
Digoxin
Which drugs should be stopped/avoided if someone is diagnosed with HF?
Calcium channel blockers
