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
what is the immediate treatment of acute HF
call for help sit them up right high flow O2 furosemide opiates - little bit of morphine - vasodilater put them in a level 2 environment inotropes CPAP (NIV) IV nitrate rule out other causes - tamponade, valve rupture, STEMI...
how does furosemide work if you have acute pulmonary oedema
potent vasodilatation
reduces preload on the heart
dilates vena cava
not the diuresis initially, does this afterwards
causes of HF due to LVSD
hypertenstion ischaemic heart disease valvular disease alcohol congenital structural disease renal failure oncology - chemo and radiotherapy DM, thyroid cocaine rheumatic heart disease myocarditis infiltration pregnancy
lifestyle management of HF
smoking cessation healthy diet - salt and fluid weight loss alcohol exercise refer to specialist HF nurses
standard medical therapies for HF
loop diuretics - furosemide/bumetanide
B blockers - bisoprolol/carvedilol
ACEI/ARBs
additional medical therapies for HF
mineralocorticoid receptor antagonists - spironolactone, eplerenone
IV iron therapy - good for symptoms
thiazide diuretics - bendroflumethiazide, metolazone
digoxin - helps as an inotrope
who should you refer HF patients to
HF nurse specialist
improve management
liaise with team
anticipatory care plans
device therapy for HF
ICD
CRT
device therapy for HF
ICD
CRT
NYHA classification
1 - no symptoms or limitations in normal physical activity
2 - mild symptoms and slight limitation during ordinary activity, comfortable at rest
3 - marked limitation in activity, comfortable only during rest
4 - severe limitations, symptoms at rest
treatment of torsades de pointes
IV magnesium
