Heart Failure Flashcards
what is acute heart failure
term used to describe sudden onset / worsening of symptoms of HF
- called ‘Denovo’ HF if no previous history
what causes acute heart failure
reduced cardiac output that results from structural / functional abnormality
how does left ventricular failure present
SOB
orthopnoea - breathless whilst lying flat
paroxysmal nocturnal dyspnoea - waking in night with severe breathlessness
pink frothy sputum
bilateral basal crackles - pulmonary oedema
third heart sound
how does right ventricular failure present
raised JVP
peripheral oedema
hepatomegaly
investigations for HF
ECG - look for ischaemia / arrythmias
ABG - HF causes type 1 rasp failure
Chest XRAY
Echo - will identify effusion / tamponade
Bloods - screen for infection, kidney dyfunction, anaemia
BNP
specific blood test done in suspected HF
BNP (beta type natriuretic peptide)
- released by ventricles in response to strain
- high result means heart is overloaded beyond capacity to pump effectively
management of acute HF
stop any fluids sit the patient up oxygen (CPAP in severe cases) diuretics - IV 40mg furosemide monitor fluid balance
other things used in severe cases but not routine are:
- IV opiates : vasodilatory effect
- Inotropes e.g. noradrenalin - strengthen force of heart contraction
1st line drugs in chronic HF
beta blocker + ACEI
- improve mortality
2nd line drugs in chronic HF
If symptoms not controlled with beta blocker + ACEI add:
- aldosterone antagonist e.g. spironolactone
what drug is given for symptom relief in chronic HF but does not improve mortality
loop diuretics e.g. furosemide
what vaccinations are given to patients with chronic HF
annual influenza vaccine
one off pneumococcal vaccine
if symptoms of chronic HF persist despite maximum drug therapy, what further options are there
cardiac resynchronisation therapy (particularly if widened QRS such as in LBBB)
OR digoxin – particularly good in AF patients
what is cor pulmonale
right sided heart failure caused by respiratory disease
- most commonly COPD
- pulmonary HTN results in right ventricle being unable to efficiently pump blood out of ventricle into pulmonary arteries
- back pressure on right atrium, vena cava + systemic venous system
signs of cor pulmonale
hypoxia / cyanosis raised JVP peripheral oedema trisuspid regurgitation third heart sound hepatomegaly
normal left ventricular ejection fraction
45 - 60 %
