Heart failure Flashcards
investigations for possible heart failure
History and examination FBC, U+E, TFT +- ferritin BNP (treat similarly to d dimer) 12 lead ECG CXR ECHO MRI - infiltrative angiogram - CAD cardiopulmonary exercise test
management of reduced EF HF
lifestyle advice - smoking cessation, reduce salt and fluids, alcohol, exercise and weight loss
Medication review - NSAIDs for fluid retention
B blocker
ACEI
Furosemide
SIGN HF guidelines
useful resource
heart failure in itself is a diagnosis?
no
it is a term describing a physiological state of abnormal cardiac pathology resulting in failure of the heart to pump to the level required
ie must say: heart failure due to…
causes of HF
LV dysfunction
valvular disease
arrhythmia
pericardial disease e.g. constrictive pericarditis
metabolic disease e.g. thyrotoxicosis, DM
what is the main ‘cause’ of HF ie
the one that is most focussed on
HF due to LV systolic dysfunction
3 types of HF described?
HF with
reduced EF <40%
preserved EF >50%
mid range EF 40-49%
how can HF be classified
acute vs chronic
left vs right
pathophysiology of left HF
back pressure from the weakened LV goes to the lungs
manifestations of LHF
SOB orthopnoea paroxysmal nocturnal dyspnoea pulmonary oedema i.e. fluid filled lungs
pathophysiology of right HF
back pressure from the weakened RV goes to the rest of the body ie liver and peripheral tissues
ie no fluid in lungs
manifestations of RHF
SOB due to pulmonary HTN
raised JVP
peripheral oedema - ankle swelling
hepatomegaly
what is bi-ventricular / combined congestive heart failure
both RHF and LHF combined resulting in pulmonary and peripheral oedema
how does acute HF / cardiogenic pulmonary oedema
very SOB cough - pink frothy sputum PND - open window sudden extremely unwell disitressed, restless sweating profusely look rubbish pale, cold clammy 3rd/4th HS
what are the common causes of acute HF
decompensation of chronic HF ischaemia - MI infection arrhythmia valvular
