Heart Failure- diagnosis and management Flashcards
What investigations would you do for someone presenting with possible heart failure?
Blood tests
Chest x-ray
Echocardiogram
B-type natriuretic peptide
What might you see on a chest x-ray of someone with heart failure?
A: Alveolar oedema (with ‘batwing’ perihilar shadowing)
B: Kerley B lines (caused by interstitial oedema)
C: Cardiomegaly (cardiothoracic ratio >0.5)
D: upper lobe blood diversion
E: Pleural effusions (typically bilateral transudates)
F: Fluid in the horizontal fissure
What might you see on an echocardiogram of someone with heart failure?
Pericardial effusion
Cardiac tamponade
What level of B-type natriuretic peptide would be diagnostic of heart failure?
Raised levels (>100mg/litre)
What do raised levels of B-type natriuretic peptide indicate?
Myocardial damage
What is the acute management of heart failure?
IV loop diuretics
What IV loop diuretics would you give for the acute management of heart failure?
IV Furosemide or
IV Bumetanide
What is the first line management of chronic heart failure?
ACE-inhibitor and a beta-blocker
Which beta-blockers could you give for chronic heart failure?
Bisoprolol
Carvedilol
Nebivolol.
In which type of heart failure do ACEi and beta-blockers have no effect?
Heart failure with preserved ejection fraction
What is the second line management of chronic heart failure?
Aldosterone antagonist
Which aldosterone antagonists would you give for chronic heart failure?
Spironolactone
Eplerenone
What is the problem with a patient taking both an aldosterone antagonist and an ACEi?
They both cause hyperkalaemia- need to monitor potassium
What third line medications could you give for heart failure?
ivabradine
sacubitril-valsartan
Digoxin
hydralazine in combination with nitrate
What additional treatment could you give someone with heart failure?
- Annual influenza vaccine
- One-off pneumococcal vaccine
