Heart failure and acute LV failure Flashcards
Define heart failure
A syndrome of impaired ability to maintain sufficient cardiac output to meet the body’s requirements (Normal CO is 5-25L/min).
How can heart failure be classified?
- Ejection fraction
- HF w/ reduced ejection fraction (HF-REF): LVEF <40%
- HF w/ preserved ejection fraction (HF-PEF)
- Acute vs chronic
- New York Heart Association (NYHA) functional classification
What is congestive heart failure?
HF with evidence of sodium and water retention
List three complications of heart failure
- Arrhythmias: esp. AF and ventricular arrhythmias
- Depression
- Cachexia
- CKD
- Sexual dysfunction
- Sudden cardiac death
Give five causes of heart failure
- Myocardial disease: CAD; Cardiomyopathy (dilated is commonest); HTN
- Valvular heart disease
- Pericardial disease
- Congenital heart disease
- Arrhythmias
- High output state: eg. anaemia; thyrotoxicosis; sepsis; cirrhosis
- Volume overload: CKD; nephrotic syndrome
- Obesity
- Drugs: alcohol; cocaine; NSAIDs; B-blockers; CCBs
Outline the NYHA classification of heart failure
Suggest three symptoms of chronic heart failure
- Exertional dyspnoea
- Dyspnoea at rest
- Orthopnoea
- Nocturnal cough
- Paroxysmal nocturnal dyspnoea
- Oedema; weight gain
- Fatigue; reduced exercise tolerance
- Light headedness; syncope
Suggest five signs of chronic heart failure
- Tachycardia
- Laterally displaced apex beat; cardiomegaly
- S3 or S4 (gallop rhythm)
- HTN
- Raised JVP
- Hepatomegaly
- Tachypnoea; basal crepitations; pleural effusion
- Dependent oedema; ascites
- Obesity
Request three investigations for suspected heart failure
-
NT-proBNP
- 400ng/L+: Specialist assessment and echocardiography
- 12-lead ECG
- CXR
- FBC; U+Es; LFTs; TFTs; HbA1c; fasting lipids
- Urine dipstick
- Lung function tests
- SPECT or PET: MI as underlying cause of heart failure
- Cardiac MRI
- Cardiac biopsy if cardiomyopathy suspected
- Exercise test: predicts admission and mortality 24hr
What radiological findings are seen in a CXR with heart failure?
What are the symptomatic management options for suspected heart failure?
Loop diuretics if symptoms are sufficiently severe, any of:
- Furosemide 20-40mg OD
- Bumetanide 0.5-1.0mg OD
- Torasemide 5-10mg OD
Add thiazide-like diuretics if loop diuretics become inadequate
Monitor daily U+Es due to risk of hypokalaemia
Provide three lifestyle advice and modifications in heart failure management
- Education: esp. weight monitoring and adjusting diuretic doses
- Consider salt and fluid restriction; avoid salt substitutes with K+
- Smoking and alcohol cessation
- Cardiac rehabilitation
- Vaccinations: Annual influenza vaccine; one time pneumococcal vaccine
- Cannot drive large lorries and buses if symptomatic
Outline the first-line medical treatment of chronic HF-REF
-
ACEi and Beta-blocker
- Start one, add second once patient is stable
- Monitor U+E; eGFR; and BP prior to starting ACEi
- Consider
- ARBs if ACEi intolerance
- Hydralazine + nitrate plus specialist input if ACEi and ARB intolerance
Outline second-line medical treatment of chronic HF-REF
Add spironolactone to previous ACEi + Beta-blocker therapy
What specialist treatments are available for HF-REF
- Ivabradine
- Sacubitril valsartan
- Hydralazine + nitrate
- Digoxin
- ICD; cardiac resynchronisation therapy