Heart Failure - booklet Flashcards
1
Q
Causes of HF
A
- Ischaemic heart disease
- HTN
- Valvular heart disease (Rheumatic fever in elderly)
- Atrial fibrillation
- Chronic lung disease
- Cardiomyopathy (hypertrophic, dilated, post viral, post-partum)
- Previous chemotherapy
- HIV
2
Q
Most patient HF type
A
- HF with reduced EF
- AKA systolic heart failure
- Is 50%
- Others have symptoms but echo shows only mild impaurment or even normal (HFpEF)
3
Q
HFpEF presentation history
A
- More elderly
- Overweight
- Hypertension
- Atrial fibrillation
4
Q
What aspects suggest worse prognosis with heart failure?
A
- Severe fluid overload
- Very high NT-proBNP levels
- Severe renal impairment
- Advanced age
- Multiple co-morbidies
- Freq admissions with HF
5
Q
Bloods for HF presentation
A
- Renal function - baseline and diuretic effect
- FBC - rule out anaemia
- LFTs - hepatic congestion
- TFTs- thyroid disease?
- Ferritin and transferrin - haemochromatosis if young
- Brain natriuretic peptide (NT-proBNP) only measure when suspect HF
6
Q
NT-proBNP other reason could be elevated
A
Any stimuli which causes increased cardiac chamber stress eg AF or RV strain
7
Q
CXR features of heart failure
A
- Cardiomegaly
- Pleural effusions?
- Perihilar shadowing/consolidation
- Alveolar oedema
- Air bronchograms
- Increased width of vascular pedicle
8
Q
How to assess LV function?
A
- Echocardiogram - key investigation to confirm diagnosis
- Cardiac MRI - may help find cause, echo sometimes misses RV, assess viable cardiac muscle
9
Q
Management HF - lifestyle
A
- Smoking cessation
- Restrict alcohol consumption
- Salt restriction
- Fluid restriction esp if hyponatraemia
- Daily weight monitoring can indentify fluid overload earlier
10
Q
Medication for HF
A
- Diuretics - furosemide/bumetanide, bendroflumethiazide, metolazone, spironolactone (in hypokalaemia)
- ACEi or ARB
- Sacubitril Valsartan - angiotensin receptor-neprilyisin inhibitor
- Beta blockers - start low and go slow
11
Q
Other vasodilators for HF
A
- Hydralazine
- Isosorbide mononitrate
- Used if patients cannot take ACEi/ARBs
12
Q
When is Ivabradine used?
A
If patients cannot tolerate beta blocker or HR still over 75 despite BB
AVOID with CCB heart specific
Has no impact on BP, used when BP is low
13
Q
When to use IV nitrates in acute HF?
A
- If underlying ischaemia, hypertension or regurgitation of aortic/mitral valve disease
- Caution in mitral and aortic stenosis, HOCM and pericardial constriction
14
Q
What do we use when medical management fails for HF?
A
- Can use cardiac resynchronisation pacemaker if LBBB (CRT)
- Implantable cardiac defibrillator - these do not improve symptoms but detect VF/VT and cardiovert these if they occur via shocking
15
Q
What happens to ECG in LBBB and why?
A
- QRS is broad
- Depolarisation of electricity is delayed from the septum to lateral wall
- Pace these two points = narrowed QRS again and heart pumps normally with CRT
