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Cardio > Heart Failure > Flashcards

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

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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
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3
Q

classification?

A
  • low output vs high output
  • right vs left sided
  • acute vs chronic
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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
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5
Q

causes of low output HF

A
  1. Pump failure
    1. systolic failure- impaired contraction
      • ischaemia/ MI
      • dilated cardiomyopathy
      • Myocarditis
    2. diastolic failure - impaired filling
      • pericardial effusion/tamponade
      • cardiomyopathy: restrictive /HOCM
    3. arrhythmias
      • brady, tachycardias & heart block
      • antiarrhythmic drugs
  2. Excessive preload
    • AR, MR
    • fluid overload
  3. Excessive afterload
    • HTN
    • AS
    • HOCM
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6
Q

causes of high output HF

A
  • anaemia
  • thyrotoxicosis
  • pregnancy, paget’s
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7
Q

causes of RVF?

A
  • PE
  • Cor pulmonale
  • LVF
  • tricuspid and pulmonary valve disease
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8
Q

clinical features of RVF

A
  • hepatosplenomegaly
  • raised JVP
  • peripheral pitting oedema
  • ascites
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9
Q

causes of LVF

A
  1. IHD
  2. dilated cardiomyopathy
  3. HTN
  4. mitral and aortic valve disease - mainly AS
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10
Q

symptoms of LVF

A
  • exertional dyspnoea
  • orthopnoea + PND
  • cough (+/- pink/frothy sputum)
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11
Q

what is PND

A

suddenly waking up at night with a severe attack of SOB + cough. symptoms improve over several minutes

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12
Q

signs of LVF

A
  • bilateral basal creps
  • pleural effusions
  • cold peripheries +/- cyanosis
  • cardiomegaly w displaced apex
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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
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14
Q

clinical features of biventricular failure?

A
  • tachycardia
  • hypotension
  • gallop rhythm (S3+ tachycardia)
  • displaced apex (dilated heart)
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15
Q

Ix?

A
  • Bloods
    • FBC
    • U&E
    • BNP & NT-ProBNP
    • TFT
    • Glucose
  • ECG
  • Echo- key investigation
  • CXR
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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

Cardio (18 decks)

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