Heart Failure Flashcards
What is the definition of heart failure?
Inability of heart to maintain adequate cardiac output to meet body’s demand
What are the different classifications of heart failure?
- Systolic failure (HFrEF) - more common
- IHD
- MI
- Ventricular dilatation
- Diastolic failure (HFpEF) - pt normally elderly, overweight, HTN and AF
- ventricular hypertrophy
- constrictive pericarditis
- tamponade
- restrictive cardiomypathy
- obesity
- Acute or chronic
- Right sided or left sided HF
What are the sx for LVF? (most common HF)
- dyspnoea
- poor exercise tolerance
- fatigue
- orthopnoea
- PND
- pink frothy sputum
What are the causes of RVF?
- LVF
- pulmonary stenosis
- lung disease (cor pulmonale)
What are the sx for RVF?
- peripheral oedema
- breathlessness
- raised JVP
- liver congestion
- ascites
What is the term used when you have both LVF and RVF?
- Congestive Heart Failure
What is acute HF?
- new-onset acute or decompensation of chronic HF
- characterised by pulmonary and/or peripheral oedema
- +/- signs of peripheral hypoperfusion
What is the Px of PND?
- Sleep flat - fluid redistributed across large surface area of lung. Stand up - fluid sinks to base fo lungs, upper lungs clear
- Respiratory centre in brain less responsive during sleep
- Less circulating adrenaline during sleep - less CO
How would you diagnose HF?
- Clinical presentation
- BNP blood test (specifically “N-terminal pro-B-type natriuretic peptide” – NT‑proBNP)
- Echocardiogram
- ECG
What are the causes of HF?
- IHD
- HTN
- Valvular disaese (Rheumatic fever)
- AF
- Chronic lung disease
- Cardiomyopathy
- Previous chemo drugs
- HIV
What criteria can you use to diagnose HF?
Framingham criteria
Why do you get a raise in BNP during HF?
- BNP produced by ventricles
- BNP released to protect heart from stress
- Act on
- bv: dilate
- kidney: excrete salt
- reduce production of adrenaline, angiotensin, aldosterone
Describe the New York classification of HF?
- I: Heart disease present, no dyspnoea from ordinary activity
- II: Comfortable at rest, dyspnoea during ordinary activity
- III: Dyspnoea at low activity
- IV: Dyspnoea at rest
What are the CXR features of HF?
*use ABCDE
- A: Alveolar oedema (bat wings)
- B: Kerley B lines
- C: Cardiomegaly
- E: Pleural Effusion
What are the first line medical treatment for HF?
*use ABAL
- ACE-i
- Ramipril 1.25mg OD
- Beta blocker
- Bisoprolol 1.25mg OD
- Aldosterone antagonist
- Eplerenone 25mg OD
- Loop diuretics
- Furosemide 40-500mg OD
How would you tx chronic HF?
- Diuretics
- If pt has fluid overload
- If HFpEF:
- Mx HTN, AF, IHD and DM
- Furosemide
- If HFrEF:
- ACEi + BB. Add Eleprenone if sx continues
- ARB if ACEi intolerable
- Specialist re-assessment +/- second line tx
- Ivabradine
- Sacubitril
- Hydralazine + Isosorbide mononitrate
- Nitrates
What physiological mechanisms will a drop in CO trigger?
- Activation of baroreceptors at carotid sinus
- Increase sympathetic drive
- Inc HR, Inc peripheral resistance
- Increase sympathetic drive
- Activation of RAAS
- Inc circulating volume
- Vasoconstriction
- Enhance sympathetic activity
Which medications for HF can prolong life?
- ACEi
- B blocker (bisoprolol, carvedilol, metaprolol)
- Spironolactone
What causes acute HF?
- Ischameic heart disease
- Acute valvular disease
- Pericardial tamponade
What is chronic heart failure?
- Progressive cardiac dysfunction due to structural and/or functional cardiac abnormalities
- Results in reduced cardiac output and/or elevated intracardiac pressures at rest or on stress
What causes chronic heart failure?
- cardiomyopathy
- ischaemic heart disease
- aortic stenosis
- atrial fibrillation
If pt remain symptomatic despite optimal tx, what interventional device can you offer?
-
Implantable cardiac defibrillator (ICD):
- important for primary and secondary prevention of sudden cardiac death (specific indications).
-
Cardiac resynchronisation therapy (CRT):
- biventricular pacing, which is indicated in certain patients with HFrEF (i.e. ≤ 35%) & prolonged QRS (i.e. ≥ 130 ms). Usually receive combined device with defibrillator.
-
Percutaneous coronary intervention (PCI):
- patients with ischaemic heart disease may be offered revascularisation therapy if indicated.
-
Cardiac transplant: highly specialised
- procedure for certain patient groups with heart failure
What Ix would you order for HF?
Bedside
- ECG
Bloods
- U&E - renal function
- FBC
- LFT
- TFT
- Ferritin & Transferrin (younger pt)
- NT-proBNP
Imaging
- CXR
What lifestyle medification would you offer for HF?
- smoking cessation
- Restrict alcohol consumption
- Salt restriction
- Fluid restriction
