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Year 3: Cardiovascular > Heart failure (Complete) > Flashcards

Heart failure (Complete) Flashcards

1
Q

Define heart failure

A

Syndrome caused by the hearts inability to provide for the bodies metabolic needs.

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2
Q

What are the three main types of heart failure?

A

Left-sided heart failure

Right-sided heart failure

Congestive heart failure: Right and left-sided heart failure combined

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3
Q

What are the types of heart failure based onset presentation of symptoms? (2)

A

Acute heart failure: Rapid presentation of symptoms

Chronic heart failure: Long-term condition

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4
Q

What are the 3 subtypes of left-sided heart failure?

A

Heart failure with reduced ejection fraction (HFrEF)

Heart failure with mid-range ejection fraction (HFmrEF)

Heart failure with preserved ejection fraction (HFpEF)

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5
Q

What must the LVEF be for HF to be considered as HFrEF?

A

LVEF < 40%

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6
Q

What must the LVEF be for HF to be considered as HFmrEF?

A

LVEF: 40-49%

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7
Q

What must the LVEF be for HF to be considered as HFpEF?

A

LVEF > 50%

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8
Q

What are the two types of heart failure based on cardiac output?

A

High output cardiac failure

Low output cardiac failure: Failure due to low output

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9
Q

What is high output cardiac failure?

A

Type of HF in which cardiac output is normal but there is increased metabolic demand which cannot be met.

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10
Q

Low output HF has two subtypes known as?

A

Diastolic HF

Systolic HF

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11
Q

What is diastolic HF?

A

Type of low output HF which occurs due to diastolic dysfunction (impaired ventricular filling)

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12
Q

What is systolic HF?

A

Type of low output HF which occurs due to systolic dysfunction (impaired myocardial contractions during systole)

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13
Q

List 4 examples of causes of diastolic HF

A

Hypertrophic obstructive cardiomyopathy (Muscles enlarge so less ventricular volume)

Restrictive cardiomyopathy (Muscles stiffen to reduced filling)

Cardiac tamponade

Constrictive pericarditis

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14
Q

List 4 examples of systolic HF

A

Ischaemic heart disease

Dilated cardiomyopathy

Myocarditis

Infiltration (e.g. haemochromatosis, sarcoidosis)

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15
Q

List 6 causes of high output cardiac failure.

A

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)

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16
Q

List examples of causes of left-sided heart failure

A

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)

17
Q

What are the 9 main signs/symptoms of left-sided HF?

A

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

18
Q

What are the two aetiological consequences of left-sided heart failure?

A

Pulmonary congestion

Systemic hypoperfusion

19
Q

List 5 causes of right-sided heart failure

A

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.

20
Q

What are the main signs/symptoms of right-sided heart failure? (9)

A

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

21
Q

How does LHF symptoms differ to RHF symptoms?

A

LHF presents with more respiratory and cyanotic symptoms

RHF presents with more swelling symptoms

22
Q

What is the main first-line investigation for patients suspected of heart failure? How should the findings be interpreted?

A

NT-proBNP

If NT-proBNP is low congestive HF is highly unlikely.

Used to rule out but cant be used to diagnose

23
Q

What other investigations alongside NT-proBNP can be ordered for patients suspected of congestive heart failure?

A

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

24
Q

What are some findings on chest X-ray indicative of heart failure?

A

ABCDE

Alveolar oedema

Kerley B line

Cardiomegaly

Dilated upper lobe vessels + Diverted upper lobe

Effusion (Transudative pleural effusion) [Blunted cardiophrenic angles]

25
Q

What is BNP and how is it produced?

A

Brain-natriuretic peptide is a hormone produced mainly by the left ventricular myocardium in response to strain

26
Q

If a patient suspected of congestive HF has an elevated BNP, what is the next course of action?

A

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

27
Q

What is the diagnostic investigation for heart failure?

A

Trans-thoracic echocardiogram

28
Q

List 6 non-cardiac causes of elevated BNP

A

Hypoxaemia (including pulmonary embolism)

GFR < 60 ml/min

Sepsis

COPD

Diabetes

Age > 70

Liver cirrhosis

29
Q

List 6 causes for a low BNP

A

Obesity

Diuretics

ACE inhibitors

Beta-blockers

Angiotensin 2 receptor blockers

Aldosterone antagonists

30
Q

What is the initial management plan for Acute heart failure? (4)

A

Sit patient up

Administer oxygen (>sats 94%)

IV furosemide (loop diuretic) and close fluid balance

Subcutanenous morphine

31
Q

What is the long-term management plan for patients diagnosed with heart failure? (4)

A

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

32
Q

What is the 2nd-line management plan for heart failure? (e.g. severe HF)

A

Aldosterone antagonists:

Spironolactone

Epleronone

33
Q

Give an example of a beta-blocker. What are the side effects of beta-blockers? (4)

A

Bispropolol , Propanolol

Bradycardia

Hypotension

Dizziness

Fatigue

Due to reduced SNS sensitivity

34
Q

Give an example of a ACE inhibitor. What are the side effects? (6)

A

Ramipril

Hyperkalaemia

Renal impairment

Dry cough

Lightheadedness

Fatigue

GI disturbances

35
Q

What are the 4 main complications of HF?

A

Respiratory failure

Renal failure - due to hypoperfusion

Acute exacerbations

Death

36
Q

What is the prognosis of HF?

A

Very poor, worse than most malignancies

50% of severe HF patients die within 2 years

Acute HF in-hospital mortality = 2-20%

Year 3: Cardiovascular (30 decks)

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