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Year 4 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

BNP?

A

brain natriuretic peptide
secreted by cardiac cells in response to high pressure within the heart
high indicates heart failure
normal = <100?

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2
Q

what drugs are used in heart failure?

A

ACEi
beta blockers
diuretics if breathless

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3
Q

lifestyle modifications in heart failure?

A 
diet (reduced salt intake)
fluid restrictions
weight loss
reduce alcohol
stop smoking
exercise
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4
Q

heart failure definition?

A

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)

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5
Q

3 types of heart failure due to LV dysfunction?

A

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%)

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6
Q

evidence and studies and exams and guidelines etc are all based on what type of heart failure?

A

heart failure due to LV systolic dysfunction

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7
Q

how can heart failure be divided?

A

left and right

acute and chronic

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8
Q

features of left heart failure?

A

SOB
orthopnoea, PND
pulmonary oedema

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9
Q

right heart failure features?

A

SOB
raised JVP
peripheral oedema
palpable liver edge

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10
Q

bi-ventricular heart failure features?

A

right and left HF combines

pulmonary and peripheral oedema

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11
Q

what is cardiogenic pulmonary oedema?

A

acute heart failure

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12
Q

how does acute HF present?

A 
very breathless
look very pale, clammy and sweaty
pink frothy sputum
distress
can have loud murmur (systolic)
bilateral crepitations
3rd/4th heart sounds
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13
Q

common causes of acute heart failure?

A 
decompensated chronic HF
arrhythmia
IHD
hypertention
circulatory failure
myopathy
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14
Q

immediate treatment for acute HF?

A 
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
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15
Q

bad signs in acute HF?

A

shock
acidosis
refractory arrhythmia

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16
Q

LVSD?

A

LV systolic dysfunction

17
Q

causes of LVSD? (things which affect LV muscle)

A

ischaemia
hypertension
toxins (alcohol, chemo, radiation)
inflammation (Myocarditis, HIV, rheumatoid)
infiltration (amyloid, sarcoid, malignancy)
metabolic (thyroid, anorexia, phaeochromocytoma)
genetic

18
Q

how do you investigate chronic HF (basic)?

A 
bloods (Hb, Us&amp;Es, thyroid function +/- ferritin-haemochromatosis)
ECG (Q waves poor R progression, LBBB)
CXR (exclude resp disease/malignancy)
BNP (high -ve predictive value)
Echo
19
Q

more specialist investigations in HF?

A

MRI (shows scars ad infiltrative processes)
angiogram (underlying coronary disease)
cardio-pulmonary exercise test (can tell between heart problem and just being unfit)

20
Q

management of chronic AF?

A 
lifestyle changes
conventional medical therapy
conventional medical therapy
advanced medical therapy
device therapy
very advanced mechanical therapy
21
Q

lifestyle changes in chronic HF?

A 
stop smoking
diet
fluid restriction
cardiac rehab/exercise (has effect on mortality, morbidity and exercise capacity)
input of heart failure nurses
22
Q

standard medical therapies in chronic HF?

A

beta blockers
ACEi
loop diuretics (cause fluid loss in chronic, reduce preload via venodilation in acute)

23
Q

addtional medical therapy in chronic HF?

A

mineralocorticoid receptor antagonists - MRAs (spironolactone, eplerenone)
IV iron therapy (often iron deficient in HF)

24
Q

advanced medical therapies in chronic HF?

A

entresto (sacubitril/valsartan combination)
thiazides (added to loop diuretic)
digoxin
(thiazides and digoxin more used in older people if struggling to treat)

25
Q

devices in HF?

A

ICD (implantable cardioverter defibrillator)

cardiac re-synchornisation therapy

26
Q

how do ICDs work?

A

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

27
Q

who gets an ICD?

A 
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)
28
Q

how does CRT work?

A

can be pacemaker or combined defibrillator
paces heart 100% of the time
improves symptoms and prognosis

29
Q

who gets CRT?

A

chronic heart failure (LV failure with EF <40%)
severe LVSD
left BBB

30
Q

medical summary?

A

beta blockers
ACEi/ARBs
MRA (spironolactone/eplerenone)
entresto

31
Q

very advanced therapy?

A

IABP
mechanical circulatory support
ECMO

32
Q

how does IABP work?

A

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

33
Q

types of mechanical circulatory support?

A

LVAD (left ventricular assist device)

ECMO

34
Q

what is ECMO?

A

extra-corporeal membrane oxygenation
bridging strategy
supports heart while decision is made for definitive treatment (transplant or VAD)
can be peripheral or central

35
Q

what is LVAD?

A

artificual heart
contiuous pump
bridge to transplant
can go home with it

36
Q

indications for heart transplant?

A

severe end stage heart failure
acute (ECMO/VAD) or chronic
no contra-indications

37
Q

contra-indications for transplant?

A

over 65
psychologically stable
renal problems/other co-morbidities

38
Q

why is immunosuppression needed for transplant?

A

infection and rejection risk

Year 4 (83 decks)

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