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Cardiology > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

what are the groups of causes of HF?

A

ischaemic heart disease, hypertension, valvular disease, pericardial disease, drugs, genetics, inflammation, metabolic, arrhythmias, cardiomyopathies, severe anaemia, pulmonary hypertension

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2
Q

what are the pericardial disease causes of HF?

A

pericarditis, pericardial effusion

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3
Q

what drugs can cause HF?

A

chemotherapeutic drugs, beta blockers, calcium channel blocks, alcohol, radiation

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4
Q

what genetic causes can lead to HF?

A

DCM, HCM, ARVC, non compaction

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5
Q

what inflammatory causes can lead to HF?

A

Myocarditis, rheumatic disease, HIV

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6
Q

What metabolic causes can lead to HF?

A

thyrotoxicosis/myxoedema, phaemotochromaia, anorexia

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7
Q

What cardiomyopathies can lead to

A

congestive, hypertrophic, restrictive (sarcoidosis, amyloidosis, hemochromatosis, endocardial fibrosis

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8
Q

what is HF with reduced ejection fraction

A

o Cardiac output is low and fails to increase normally with exertion

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9
Q

what are the causes of HF with reduced ejection fraction?

A

Pump Failure – systolic and/or diastolic HF, reduced heart rate (b-blockers, heart block, post MI), negatively inotropic drugs (antiarrhytmias), excessive preload (mitral regurgitation or fluid overload – NSAIDS), chronic excessive afterload (aortic stenosis, hypertension)

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10
Q

what is HF with preserved ejection fraction?

A

o Rare, cardiac output is normal or increased in the face of increased needs. Failure occurs when cardiac output fails to meet these needs.

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11
Q

what are the causes of HF with preserved ejection fraction?

A

anaemia, pregnancy, hyperthyroidism, pagets disease, arteriovenous malformation, beri beri

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12
Q

What is systolic HF?

A

inability of ventricle to contract normally resulting in reduced cardiac output. Ejection fraction (EF) is <40%.

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13
Q

What is diastolic HF?

A

inability of ventricle to relax and fill normally causing increased filling pressures. EF is >50%.

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14
Q

What are the symptoms of LHF?

A

dyspnoea, poor exercise tolerance, fatigue, orthopnoea, paroxysmal nocturnal dyspnoea, nocturnal cough, wheeze, nocturia, cold peripheries, weight loss, muscle wasting

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15
Q

What are causes of systolic HF?

A

IHD, MI, cardiomyopathy

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16
Q

what are the causes of diastolic HF?

A

constrictive pericarditis, tamponade, restrictive cardiomyopathy, hypertension.

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17
Q

what are the causes of RHF?

A

LVF, pulmonary stenosis, lung disease

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18
Q

what are the symptoms of LHF?

A

peripheral oedema, ascites, nausea, anorexia, facial engorgement, pulsation in neck and face, epistaxis

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19
Q

what are the different classifications of HF?

A

HF with reduced ejection fraction, HF with preserved ejection fraction, HF with mid range ejection fraction, systolic HF, diastolic HF, left HF, right HF, acute HF, chronic HF

20
Q

what is acute HF?

A

new onset acute or decompensation of chronic heart failure characterised by pulmonary and/or peripheral oedema with or without signs of peripheral hypoperfusion

21
Q

what is chronic HF?

A

develops or progresses slowly. Venous congestion is common but arterial pressure is well maintained until very late

22
Q

what is the main form of HF?

A

left ventricular systolic dysfunction

23
Q

what are the symptoms of HF?

A 
o	Dyspnoea
o	Orthopnoea
o	Paroxysmal nocturnal dyspnoea 
o	Fatigue, lethargy, exercise intolerance
o	Peripheral swelling
o	Weight loss
o	Wheeze
o	Cough – “frothy pink sputum”
24
Q

What are the signs of HF?

A

Fluid overload - Peripheral oedema – ankles+/- sacrum, Ascites, Elevated JVP (right sided HF)
Also: Pulsus alternans, Hypotension, Cardiac heave, Displaced apex beat, Gallop (S3), Cardiomegaly on CXR, Bilateral crpeitations +/- wheeze, Cachexia (decreased appetite, weight loss, lethargy, muscle, atrophy), Hepatic tenderness/hepatomegaly

25
Q

What investigations should be carried out?

A

ECG, bloods, CXR, BNP, Echo, MRI, angiogram, CPEX

26
Q

what features will be seen in ECG of HF?

A

q waves, poor r progression, LBBB (if normal >90% that they are fine)

27
Q

which bloods should be done in HF?

A

Hb, U&E, TFT, Ferritin

28
Q

what features will be seen in CXR of HF?

A 
baseline, ensure euvolemic, exclude resp disease/malignancy
o	Alveolar oedema (Bat wings)
o	B Kerley B lines (interstitial oedema)
o	Cardiomegaly
o	Dilated prominent upper lobe vessels
o	E Pleural effusion
29
Q

what features of BNP will be seen in HF?

A

high negative predictive value, if elevated ca guide response to treatment
o Peptides that cause natriuresis, diuresis and vasodilation.

30
Q

what features will be seen in an Echo of HF?

A

quantify LVSD, identify valve disease, assess right heart pressures, other causes

31
Q

What is the grading system of HF?

A

Grade I-IV

32
Q

what is the definition of grade I HF?

A

limitation of function

33
Q

what is the definition of grade II HF?

A

Slight limitation. Moderate exertion causes symptoms, but no symptoms at rest

34
Q

what is the definition of grade III HF?

A

Marked limitation – mild exertion causes symptoms, but no symptoms at rest

35
Q

what is the definition of grade IV HF?

A

Severe limitation. Any exertion causes symptoms. May also have symptoms at rest – but not always the case

36
Q

What is the lifestyle management of HF?

A

Smoking Cessation
Diet - salt intake, weight loss, stop alcohol
Fluid restriction
Cardiac rehab

37
Q

which medications are involved in treatment of HF?

A 
Loop Diuretics (also thiazides, potassium sparing)
B Blockers
ACE, ARBS
Mineralocorticoid antagonists
IV iron
Entresto
Digoxin
38
Q

what are the device therapies of HF?

A

ICD

CRT

39
Q

what are the advanced therapies of HF?

A

IABP
LVAD
ECMO
Transplant

40
Q

what is the first line treatment for HF?

A

ACE inhibitors or ARB

41
Q

what is the second line treatment for HF?

A

ADD diuretic

42
Q

what is the third line treatment for HF?

A

ADD betablocker

43
Q

what is the fourth line treatment for HF?

A 
ADD aldosterone 
(then increase all to maximum tolerated doses)
44
Q

what other considerations can be added to management of HF?

A

CONSIDER ARNI (and cease ACE-i) for patients who remain with an EF <40%
CONSIDER ivabradine
CONSIDER another vasodilator, e.g. isosorbide dinitrate or hydralazine
CONSIDER digoxin
CONSIDER implantable cardiac devices

45
Q

What are the causes of acute HF?

A

MI, valve rupture, sustained arrhythmia, weak heart + fluid balance wrong

46
Q

what is the presentation of acute HF?

A

cold, clammy, pale, murmurs, bilateral crepitations

47
Q

what is the treatment of acute HF?

A

IV diuretic, oxygen, vasopressors, opiates (opiates dilate veins – reduces pre load)

Cardiology (9 decks)

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