Heart failure (Complete) Flashcards
Define heart failure
Syndrome caused by the hearts inability to provide for the bodies metabolic needs.
What are the three main types of heart failure?
Left-sided heart failure
Right-sided heart failure
Congestive heart failure: Right and left-sided heart failure combined
What are the types of heart failure based onset presentation of symptoms? (2)
Acute heart failure: Rapid presentation of symptoms
Chronic heart failure: Long-term condition
What are the 3 subtypes of left-sided heart failure?
Heart failure with reduced ejection fraction (HFrEF)
Heart failure with mid-range ejection fraction (HFmrEF)
Heart failure with preserved ejection fraction (HFpEF)
What must the LVEF be for HF to be considered as HFrEF?
LVEF < 40%
What must the LVEF be for HF to be considered as HFmrEF?
LVEF: 40-49%
What must the LVEF be for HF to be considered as HFpEF?
LVEF > 50%
What are the two types of heart failure based on cardiac output?
High output cardiac failure
Low output cardiac failure: Failure due to low output
What is high output cardiac failure?
Type of HF in which cardiac output is normal but there is increased metabolic demand which cannot be met.
Low output HF has two subtypes known as?
Diastolic HF
Systolic HF
What is diastolic HF?
Type of low output HF which occurs due to diastolic dysfunction (impaired ventricular filling)
What is systolic HF?
Type of low output HF which occurs due to systolic dysfunction (impaired myocardial contractions during systole)
List 4 examples of causes of diastolic HF
Hypertrophic obstructive cardiomyopathy (Muscles enlarge so less ventricular volume)
Restrictive cardiomyopathy (Muscles stiffen to reduced filling)
Cardiac tamponade
Constrictive pericarditis
List 4 examples of systolic HF
Ischaemic heart disease
Dilated cardiomyopathy
Myocarditis
Infiltration (e.g. haemochromatosis, sarcoidosis)
List 6 causes of high output cardiac failure.
Mneomonic AAPPTT
A: Anaemia
A: Ateriovenous malformation
P: Pregnancy
P: Paget’s disease (abnormal new bone has more vasculature so more demand from heart to pump blood)
T: Thyroidtoxicosis
T: Thiamine deficiency (Wet Beri Beri)
List examples of causes of left-sided heart failure
Vascular causes:
Aortic stenosis
Aortic regurgitation
Mitral regurgitation
Muscular causes:
Ischaemia (IHD)
Cardiomyopathy
Myocarditis
Arrhythmias (AF)
Systemic causes:
Hypertension
Amyloidosis
Drugs (e.g. cocaine, chemo)
What are the 9 main signs/symptoms of left-sided HF?
Signs/Symptoms of pulmonary congestion:
Exertional dyspnoea
Orthopnoea
Paroxysmal nocturnal dysponoea (Wake up gasping for air)
Nocturnal cough
Tacchypnoea
Bi-basal fine crackles
Signs of systemic hypoperfusion
Cyanosis
Reduced CRT
Hypotension
What are the two aetiological consequences of left-sided heart failure?
Pulmonary congestion
Systemic hypoperfusion
List 5 causes of right-sided heart failure
Valcular causes:
Tricuspid regurgitation
Pulmonary valve disease
Lung causes:
Pulmonary hypertension (cor pulmonale)
Pulmonary embolism
Chronic lung disease e.g. interstitial lung disease, cystic fibrosis.
What are the main signs/symptoms of right-sided heart failure? (9)
Ankle swelling
Weight gain
Abdominal distension and discomfort
Anorexia/Nausea (due to impaired liver function and ascites compressing GI tract and neurohormonal imbalances due to RHF)
Raised JVP
Pitting ankle/sacral oedema
Tender smooth hepatomegaly
Ascites
Bialateral pleural effusions
What histological findings in the liver occur due to chronic venous congestion secondary to RHF?
Nutmeg liver
How does LHF symptoms differ to RHF symptoms?
LHF presents with more respiratory and cyanotic symptoms
RHF presents with more swelling symptoms
What is the main first-line investigation for patients suspected of heart failure? How should the findings be interpreted?
NT-proBNP
If NT-proBNP is low congestive HF is highly unlikely.
Used to rule out but cant be used to diagnose
What other investigations alongside NT-proBNP can be ordered for patients suspected of congestive heart failure?
Bedside:
ECG
Bloods:
NT-proBNP
FBC: anaemia)
U&Es: For meds
LFT: For hepatic congestion)
TFTs: Check thyrotoxicosis
Glucose: Assess cardiovascular risk
Lipid profile: Assess cardiovascular risk
Imaging:
Echocardiogram
CXR
What are some findings on chest X-ray indicative of heart failure?
ABCDE
Alveolar oedema
Kerley B line
Cardiomegaly
Dilated upper lobe vessels + Diverted upper lobe
Effusion (Transudative pleural effusion) [Blunted cardiophrenic angles]
What is BNP and how is it produced?
Brain-natriuretic peptide is a hormone produced mainly by the left ventricular myocardium in response to strain
If a patient suspected of congestive HF has an elevated BNP, what is the next course of action?
Trans-thoracic echocardiogram
If 400-2000 = 6 week referal for specialist assessment and an ECHO
If >2000 = urgent 2 week referal for specialist assessment and an ECHO
What is the diagnostic investigation for heart failure?
Trans-thoracic echocardiogram
List 6 non-cardiac causes of elevated BNP
Hypoxaemia (including pulmonary embolism)
GFR < 60 ml/min
Sepsis
COPD
Diabetes
Age > 70
Liver cirrhosis
List 6 causes for a low BNP
Obesity
Diuretics
ACE inhibitors
Beta-blockers
Angiotensin 2 receptor blockers
Aldosterone antagonists
What is the initial management plan for Acute heart failure? (4)
Sit patient up
Administer oxygen (>sats 94%)
IV furosemide (loop diuretic) and close fluid balance
Subcutanenous morphine
What is the long-term management plan for patients diagnosed with heart failure? (4)
Treat the underlying cause
Pharmacological: For symptom management
ACE inhibitors
Beta-blockers
Diuretics
Lifestyle:
Smoking cessation
Reduced salt intake
Exercise
Offer pnueomoccocal vaccine and annual flu vaccination
What is the 2nd-line management plan for heart failure? (e.g. severe HF)
Aldosterone antagonists:
Spironolactone
Epleronone
Give an example of a beta-blocker. What are the side effects of beta-blockers? (4)
Bispropolol , Propanolol
Bradycardia
Hypotension
Dizziness
Fatigue
Due to reduced SNS sensitivity
Give an example of a ACE inhibitor. What are the side effects? (6)
Ramipril
Hyperkalaemia
Renal impairment
Dry cough
Lightheadedness
Fatigue
GI disturbances
What are the 4 main complications of HF?
Respiratory failure
Renal failure - due to hypoperfusion
Acute exacerbations
Death
What is the prognosis of HF?
Very poor, worse than most malignancies
50% of severe HF patients die within 2 years
Acute HF in-hospital mortality = 2-20%
