Heart Failure Flashcards
1
Q
what is it?
A
when CO is inadequate for body’s requirements
heart unable to pump blood at a rate required by metabolising tissues
2
Q
pathophysiology?
A
- reduced CO initially–> compensatory mechanisms kick in
- RAAS activation
- Adrenergic activation
- increased HR/Contractility
- vasoconstriction
- direct cardiotoxicity
- progressive reduction in CO–> decompensation
3
Q
classification?
A
- low output vs high output
- right vs left sided
- acute vs chronic
4
Q
what is low/high output HF
A
- low- CO reduces and fails to increase w exertion
- high- CO higher than normal to meet increased metabolic demand
5
Q
causes of low output HF
A
- Pump failure
- systolic failure- impaired contraction
- ischaemia/ MI
- dilated cardiomyopathy
- Myocarditis
- diastolic failure - impaired filling
- pericardial effusion/tamponade
- cardiomyopathy: restrictive /HOCM
- arrhythmias
- brady, tachycardias & heart block
- antiarrhythmic drugs
- systolic failure- impaired contraction
- Excessive preload
- AR, MR
- fluid overload
- Excessive afterload
- HTN
- AS
- HOCM
6
Q
causes of high output HF
A
- anaemia
- thyrotoxicosis
- pregnancy, paget’s
7
Q
causes of RVF?
A
- PE
- Cor pulmonale
- LVF
- tricuspid and pulmonary valve disease
8
Q
clinical features of RVF
A
- hepatosplenomegaly
- raised JVP
- peripheral pitting oedema
- ascites
9
Q
causes of LVF
A
- IHD
- dilated cardiomyopathy
- HTN
- mitral and aortic valve disease - mainly AS
10
Q
symptoms of LVF
A
- exertional dyspnoea
- orthopnoea + PND
- cough (+/- pink/frothy sputum)
11
Q
what is PND
A
suddenly waking up at night with a severe attack of SOB + cough. symptoms improve over several minutes
12
Q
signs of LVF
A
- bilateral basal creps
- pleural effusions
- cold peripheries +/- cyanosis
- cardiomegaly w displaced apex
13
Q
CXR features of LVF
A
ABCDEF
- Alveolar shadowing (oedema)
- Kerley B lines
- fluid in septal lines
- Cardiomegaly: cardiothoracic ratio >0.5
- Upper lobe Diversion
- upper lobe veins fill with blood and become engorged: increased prominence and diameter on CXR
- Effusions
- Fluid in fissures
14
Q
clinical features of biventricular failure?
A
- tachycardia
- hypotension
- gallop rhythm (S3+ tachycardia)
- displaced apex (dilated heart)
15
Q
Ix?
A
- Bloods
- FBC
- U&E
- BNP & NT-ProBNP
- TFT
- Glucose
- ECG
- Echo- key investigation
- CXR
16
Q
what are BNP and NT-ProBNP?
A
- hormones released from heart ventricles when myocardium stretched beyond normal capacity
- diagnostic markers of cardiac insufficiency - both raised in pts with HF
- levels correlate with severity of HF
- sensitive but not specific
- if BNP not raised, exlcudes HF
17
Q
Mx?
A
- Treat underlying cause / precipitants
- Conservative
- optimise underlying conditions & co-morbidities
- correct modifiable risk factors
- low salt diet / fluid restriction
- immunisation w pneumococcal & influenza vaccine
- Medical - ABAL
- ACEI/ARB
- Beta blocker
- Aldosterone antagonist
- Loop Diuretic
- digoxin / nitrates
18
Q
in who should u avoid ACEI?
A
pts w valvular heart disease
19
Q
triggers for acute LVF
A
- MI
- sepsis
- Arrhythmias
20
Q
presentation of Acute LVF
A
- rapid onset dyspnoea
- exacerbated by lying flat & improved on sitting up
- Type 1 resp failure
- lung tissues & alveoli become full of interstitial fluid which interferes with normal gas exchange
- Cough
21
Q
O/E in acute LVF?
A
- increased RR
- tachycardia
- reduced o2 sats
- 3rd HS
- bilateral bibasal crackles
- hypotension in severe cases –> cardiogenic shock
22
Q
Mx of acute LVF
A
POUR SOD
- Pour away (stop) IV fluids
- Sit upright
- Oxygen if sats falling
- Diuretics- IV Furosemide
monitor fluid balance!!!
23
Q
other options in severe pul oedema/cardiogenic shock?
A
- IV opiates –> vasodilate
- NIV/CPAP
- Inotropes
