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Cardiovascular Medicine > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is heart failure?

A

The inability of the heart to meet the demands of the body.

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2
Q

What is systolic failure?

Name some causes

A

The inability of the ventricle to contract normally, resulting in reduced cardiac output.
Causes - IHD, MI, cardiomyopathy, arrythmia

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3
Q

What is the ejection fraction in systolic failure?

A

<40%

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4
Q

What is diastolic failure?

Name some causes

A

Inability of the ventricle to relax and fill normally, causing reduced EDV
Causes - Ventricular hypertrophy, constrictive pericarditis, tamponade, restrictive cardiomyopathy, obesity

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5
Q

What is the ejection fraction with diastolic failure?

A

> 50%

Called HF with preserved ejection fraction

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6
Q

Why does cardiac output reduce in heart failure?

A
  1. Excessive preload (mitral stenosis, renal failure) - Causes ventricular dilation, which exacerbates pump failure.
  2. Pump failure
  3. Chronic excessive afterload (hypertension, aortic stenosis) - More pressure against which the ventricle is contracting. Causes ventricular hypertrophy, stiff walls then diastolic dysfunction.
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7
Q

What are the 4 classifications of heart failure?

A

Class I - No symptomatic limitation of physical activity
Class II - Slight limitation of activity, ordinary activity causes symptoms, no symptoms at rest.
Class III - Marked limitation of activity, less than ordinary activity causes symptoms, no symptoms are rest.
Class IV - Symptoms at rest, inability to do any physical activity without symptoms.

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8
Q

What are some symptoms of left sided heart failure?

A
  • Dyspnoea
  • Poor exercise tolerance
  • Fatigue
  • Orthopnea
  • PND
  • Nocturnal cough (with pink frothy sputum)
  • Wheeze
  • Nocturia
  • Cold peripheries
  • Weight loss
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9
Q

What are some signs that can occur in heart failure?

A
  • Cardiomegaly - Displaced apex beat
  • Pulmonary oedema - Basal pulmonary crackles
  • Cyanosis
  • Reduced BP
  • RV heave (pulmonary hypertension)
  • Elevated JVP
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10
Q

What are some causes of right ventricular heart failure?

A
  • LVF
  • Pulmonary stenosis
  • Lung disease (cor pulmonale)
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11
Q

What are some symptoms of right ventricular heart failure?

A
  • Peripheral oedema (up to thighs, sacrum, abdominal wall)
  • Ascites
  • Nausea
  • Facial engorgement
  • Epistaxis
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12
Q

What is high output cardiac failure?

What are some causes?

How does it present?

A

Cardiac output is normal/increased in the face of increased needs. Failure occurs when cardiac output does not meet the needs.
It can occur with a normal heart.

Causes -

  • Anaemia
  • Pregnancy
  • Paget’s disease
  • AV malformation
  • Initially features of right sided heart failure, then left
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13
Q

What bloods would you do for a patient with suspected heart failure and why?

A
  • FBC - Anaemia
  • U+E - Baseline and diuretic effect
  • LFT - Baseline and hepatic congestion
  • TFT’s - Thyroid disease
  • Ferritin and transferrin if young (hereditary haemachromatosis)
  • NT-proBNP (less than 100 can rule out heart failure)
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14
Q

What would a CXR show in heart failure?

A 
A - Alveolar oedema - perihilar bats wing shadowing
B - Kerley B lines 
C - Cardiomegaly (>50% on PA film)
D - Dilated prominent upper lobe veins
E - Pleural effusion
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15
Q

How would you assess LV function in heart failure patients?

A

Echocardiogram is the KEY investigation.

  • It may indicate the cause of failure eg MI, valvular problem
  • Confirms the presence or absence of LV dysfunction

Cardiac MRI can also be used as echo may miss right ventricle. Can assess viability of cardiac muscle.

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16
Q

What is the standard workup for a heart failure patient?

A
  1. Bloods - FBC, U+E, BNP
  2. CXR
  3. ECG
  4. ECHO
17
Q

What lifestyle modifications should a patient with heart failure take?

A
  1. Smoking cessation
  2. Restrict alcohol consumption
  3. Salt restriction
  4. Fluid restriction - especially in presence of hyponatraemia
18
Q

What medications should you start a patient on in heart failure?

A
  1. Diuretics and ACE-i’s first line
  2. add Beta blockers
  3. add Mineralcorticoid receptor antagonists
19
Q

What diuretics should you put a patient on and why?

A
  • First line furosemide
  • Most effective symptomatic treatment
  • Thiazide diuretics can be added on
20
Q

What do you need to monitor on an inpatient on diuretics?

A
  • Renal function
  • Fluid input and output
  • Daily weight
21
Q

Why do you give ACE-i’s in heart failure?

A
  • Useful if the patient is also hypertensive
  • Improve signs and symptoms of heart failure
  • Improve exercise tolerance, slow disease progression and improve survival
22
Q

What do you need to monitor with a patient on an ACE-i?

A
  • Renal function (Na+ and K+)
23
Q

Why do you give beta blockers to a patient with heart failure?

A
  • Improve survival after a MI. Useful in diastolic dysfunction, help with coexisting angina.
  • Start low and go slow
24
Q

Why would you give nitrates in a patient with heart failure?

A
  • Nitrates reduce preload, reduce pulmonary oedema and reduce ventricular size
  • Useful in acute heart failure (IV)
  • If chronic, relieves orthopnoea and exertional dyspnoea
25
Q

When do you give ivabradine?

A
  • When patient cannot tolerate beta blockers, it slows the heart rate
  • Resting HR is over 75 despite beta blockers
  • Patient must be in sinus rhythm
26
Q

When do you give hydralazine?

A
  • When patients cannot tolerate ACEi/ARBs
27
Q

What complex device therapy can be offered?

A
  • Pacemakers - if evidence of LBBB (CRT)
  • Implantable cardiac defibrillators - Do not improve symptoms, but prevent sudden cardiac death associated with heart failure by cardioverting VT.

Cardiovascular Medicine (14 decks)

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