Heart Failure Flashcards
Define HF
Cardiac output is inadequate for body’s requirements
Define systolic failure
Inability of ventricle to contract normally, resulting in decreased cardiac output
Define diastolic failure
Inability of ventricle to relax and fill normally, causing increased filling pressures
What is HFpEF?
Heart failure with preserved EF
What is CCF a combination of?
LVF and RVF
Define acute HF
New-onset acute or decompensation of chronic HF characterised by pulmonary and/or peripheral oedema with or without signs of peripheral hypoperfusion
Define chronic HF
Develops or progresses slowly
What are some causes of SF?
IHD, MI, Cardiomyopathy
What are some causes of DF?
Aortic stenosis, chronic HTN
What are some causes of RHF?
Right ventricular infarct, PH, PE, COPD, LHF, Cor pulmonale
How does LVF present?
Dyspnoea, fatigue, orthopnoea, poor exercise tolerance, nocturnal cough, wheeze, nocturia, cold peripheries
How does RVF present?
Peripheral oedema, ascites, nausea, facial engorgement, epistaxis
What is epistaxis?
Nose bleed
What are signs of general HF?
Elevated JVP, 3rd or 4th heart sounds, displaced apex beat, murmurs, bibasal crackles
What criteria do you use for CCF?
Framingham criteria
What two tests would you do first?
ECG and B-type natriuretic peptide
Where is BNP secreted from?
Ventricular myocardium
What causes an increase in plasma BNP?
MI, LV dysfunction, tachycardia
How do ANP and BNP work?
They help stretched atria and ventricles by increasing GFR, decreasing Na+ reabsorption, relaxing smooth muscle
What is the overall effect of ANP and BNP?
Reduced fluid load and preload
When would you do an echo?
If ECG or BNP are abnormal
What signs can you see on a CXR in LVF?
ABCDE. Alveolar oedema (Bat’s wings), kerley B lines, Cardiomegaly, Dilated prominent upper lobe vessels, pleural Effusion
What lifestyle changes would you make in chronic HF?
Stop smoking and alcohol, eat less salt, optimise weight and nutrition
What drug options do you have?
Diuretics, ACE-i, Beta-blockers, mineralocorticoid receptor antagonists, digoxin
When would you consider ACE-i?
In all LVSD
When would you give ARB?
If cough from ACE-i is a problem
When would you add Digoxin?
In patients with LVSD
What classification system is used for HF?
New York Classification of HF
What is stage I?
Heart disease present with no undue dyspnoea from ordinary activity
What is stage II?
Comfortable at rest, dyspnoea during ordinary activity
What is stage III?
Less than ordinary activity causes dyspnoea, limiting
What is stage IV?
Dyspnoea present at rest, all activity causes discomfort
What can cause LHF?
Coronary artery disease, MI, Cardiomyopathy, Congenital heart defects, valvular heart disease, arrhythmias
How do diuretics help?
They reduce preload and pressures on ventricles
Give an example of an ACE-i
Ramipril
Give an example of a beta-blocker
Bisoprolol
Give an example of a mineralocorticoid receptor antagonist
Spironolactone
Which diuretic/mineralocorticoid receptor antagonist is potassium sparing?
Spironolactone
Give some examples of diuretics
Furosemide, bendroflumethazide, spironolactone
What is the action of amlodipine?
Inhibition of L-type voltage gated calcium channel in the nephron
What is the action of spironolactone?
Inhibition of aldosterone receptor in the distal tubules
What is the action of thiazide-like diuretics?
Inhibition of the sodium chloride transporter in the distal convoluted tubule
What is the action of furosemide?
Inhibition of the sodium/potassium/chloride symporter in the ascending limb of the loop of Henle
What are the three cardinal signs of HF?
Shortness of breath, fatigue, ankle swelling
