Heart failure Flashcards
what is the first line treatment for heart failure?
beta blocker + ACE inhibitor
start one for 2 weeks then add on the other
if you start 2 at the same time then causes severe hypotension
what is the 2nd line treatment for heart failure?
aldosterone antagonist e.g. spironolactone
SGLT2 inhibitor (with reduced ejection fraction)
what is the 3rd line treatment options for heart failure?
digoxin - coexisting AF
ivabradine HR > 75 + REF < 35%
sacubitril valsartan - REF < 35%
cardiac resynchronisation - REF < 35%
cardiac ICD
what are the indications for ivabradine in the treatment of heart failure?
3rd line option if sinus rhythm with HR > 75
LVEF < 35%
what are the indications for digoxin in the treatment of heart failure?
3rd line if co-existing AF
what are the indications for sacubitril valsartan in the treatment of heart failure?
3rd line if LVEF < 35% and HR < 75 bpm
what are the indications for cardiac resynchornisation in the treatment of heart failure?
3rd line option if LVEF < 35%, been on a few medications and prolonged QRS (LBBB)
when would a patient with heart failure be put on long term 02?
if Pa02 < 7.3 / 53mmHg
what is the long term vaccines for patients with heart failure?
once off pneumococcal vaccine
annual influenza
annual influenza vaccine
what are features on CXR of heart failure?
alveolar oedema
kersey B lines
cardiomegaly
diffuse upper lobe vessels
pleural effusion
at what BNP level is abnormal?
> 100 mol/L
at what BNP level is an echo arranged?
> 100 - abnormal
200 - within 6 weeks
400 - within 2 weeks
acute heart failure -urgent
what is the classification of heart failure?
NYHA classification
I - asymptomatic
II - symptomatic during physical exercise
III - symptomatic with less than ordinary physical activity
IV - symptomatic at rest
if a patient presents with an acute presentation of heart failure with significant breathlessness, what is the 1st line treatment?
IV furosemide
when is an ICD preferred for treatment of heart failure?
risk of sudden cardiac failure or life threatening arrhythmia
- LVEF < 30% and prolonged QRS > 120ms
