Heart failure (Complete) Flashcards by Sydney Carrera-Brown

Define heart failure

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

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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

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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

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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)

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

LVEF < 40%

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

LVEF: 40-49%

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

LVEF > 50%

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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

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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.

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Low output HF has two subtypes known as?

Diastolic HF

Systolic HF

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What is diastolic HF?

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

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What is systolic HF?

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

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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

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List 4 examples of systolic HF

Ischaemic heart disease

Dilated cardiomyopathy

Myocarditis

Infiltration (e.g. haemochromatosis, sarcoidosis)

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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)

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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%