Heart Failure Flashcards
BNP?
brain natriuretic peptide
secreted by cardiac cells in response to high pressure within the heart
high indicates heart failure
normal = <100?
what drugs are used in heart failure?
ACEi
beta blockers
diuretics if breathless
lifestyle modifications in heart failure?
diet (reduced salt intake) fluid restrictions weight loss reduce alcohol stop smoking exercise
heart failure definition?
state where an abnormality of cardiac function is responsible for the failure of the heart to pump blood at a rate commensurate with the requirements of the metabolising tissues
(not a firm diagnosis really so should always define what causing it - eg heart failure due to LV dysfunction or AF etc)
3 types of heart failure due to LV dysfunction?
heart failure with reduced ejection fraction (EF <40%)
heart failure with preserved ejection fraction (EF >50%)
heart failure with med-range ejection fraction (EF 40-49%)
evidence and studies and exams and guidelines etc are all based on what type of heart failure?
heart failure due to LV systolic dysfunction
how can heart failure be divided?
left and right
acute and chronic
features of left heart failure?
SOB
orthopnoea, PND
pulmonary oedema
right heart failure features?
SOB
raised JVP
peripheral oedema
palpable liver edge
bi-ventricular heart failure features?
right and left HF combines
pulmonary and peripheral oedema
what is cardiogenic pulmonary oedema?
acute heart failure
how does acute HF present?
very breathless look very pale, clammy and sweaty pink frothy sputum distress can have loud murmur (systolic) bilateral crepitations 3rd/4th heart sounds
common causes of acute heart failure?
decompensated chronic HF arrhythmia IHD hypertention circulatory failure myopathy
immediate treatment for acute HF?
sit upright give oxygen IV furosemide (redcues pre-load via venodilation) IV nitrate (GTN) morphine (also causes venodilation) CPAP (if struggling) give inotropes if hypotensive DONT GIVE BETA BLOCKER IN ACUTE rule out other causes
bad signs in acute HF?
shock
acidosis
refractory arrhythmia
LVSD?
LV systolic dysfunction
causes of LVSD? (things which affect LV muscle)
ischaemia
hypertension
toxins (alcohol, chemo, radiation)
inflammation (Myocarditis, HIV, rheumatoid)
infiltration (amyloid, sarcoid, malignancy)
metabolic (thyroid, anorexia, phaeochromocytoma)
genetic
how do you investigate chronic HF (basic)?
bloods (Hb, Us&Es, thyroid function +/- ferritin-haemochromatosis) ECG (Q waves poor R progression, LBBB) CXR (exclude resp disease/malignancy) BNP (high -ve predictive value) Echo
more specialist investigations in HF?
MRI (shows scars ad infiltrative processes)
angiogram (underlying coronary disease)
cardio-pulmonary exercise test (can tell between heart problem and just being unfit)
management of chronic AF?
lifestyle changes conventional medical therapy conventional medical therapy advanced medical therapy device therapy very advanced mechanical therapy
lifestyle changes in chronic HF?
stop smoking diet fluid restriction cardiac rehab/exercise (has effect on mortality, morbidity and exercise capacity) input of heart failure nurses
standard medical therapies in chronic HF?
beta blockers
ACEi
loop diuretics (cause fluid loss in chronic, reduce preload via venodilation in acute)
addtional medical therapy in chronic HF?
mineralocorticoid receptor antagonists - MRAs (spironolactone, eplerenone)
IV iron therapy (often iron deficient in HF)
advanced medical therapies in chronic HF?
entresto (sacubitril/valsartan combination)
thiazides (added to loop diuretic)
digoxin
(thiazides and digoxin more used in older people if struggling to treat)
devices in HF?
ICD (implantable cardioverter defibrillator)
cardiac re-synchornisation therapy
how do ICDs work?
delivers bradycardia pacing, anti-tachycardia pacing and shocks
treats ventricular arrhythmias and any brady-arrhythmia
tries to correct arryhthmia first then shocks if pacing doesnt work
who gets an ICD?
LV failure due to LVSD with ejection fraction <35% primary prevention (no previous arrhytmia, high risk of sudden cardiac death, essentially indicated in severe LVSD with EF<35%) secondary prevention (survivors of cardiac arrest or haemodynamically unstable ventricular arrhythmias such as VT)
how does CRT work?
can be pacemaker or combined defibrillator
paces heart 100% of the time
improves symptoms and prognosis
who gets CRT?
chronic heart failure (LV failure with EF <40%)
severe LVSD
left BBB
medical summary?
beta blockers
ACEi/ARBs
MRA (spironolactone/eplerenone)
entresto
very advanced therapy?
IABP
mechanical circulatory support
ECMO
how does IABP work?
inserted via femoral artery
inflates in diastole (reduces afterload) and deflates in systole (increases coronary perfusion)
increases oxygen delivery to the heart
gives heart more blood and reduces pressure
only temporary measure (days to week) used as bridge to definitive treatment
used in acute situations such as cardiogenic shock
types of mechanical circulatory support?
LVAD (left ventricular assist device)
ECMO
what is ECMO?
extra-corporeal membrane oxygenation
bridging strategy
supports heart while decision is made for definitive treatment (transplant or VAD)
can be peripheral or central
what is LVAD?
artificual heart
contiuous pump
bridge to transplant
can go home with it
indications for heart transplant?
severe end stage heart failure
acute (ECMO/VAD) or chronic
no contra-indications
contra-indications for transplant?
over 65
psychologically stable
renal problems/other co-morbidities
why is immunosuppression needed for transplant?
infection and rejection risk
