Heart Failure Investigations And Management Flashcards by Callum Donoher

What is NYHA?

A measure of Breathlessness

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What is Class I of Heart Failure on NYHA?

Class I: No symptomatic limitation of physical activity

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What is Class II of Heart Failure on NYHA?

Class II: Slight limitation of physical activity, no symptoms at rest

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What is Class III of Heart Failure on NYHA?

Class III: Marked limitation of physical activity, no symptoms at rest, less than normal physical activity results

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What is Class IV of Heart Failure on NYHA?

Class IV: Inability to carry out physical activity without symptoms, symptoms at rest, discomfort increases with any activity

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What are some symptoms of heart failure?

Shortness of breath
Swelling of feet/legs (peripheries)
Fatigue
Difficulty sleeping at night due to breathing problems
Cough with frothy sputum
Increased urination at night
Confusion and/or impaired memory

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Why can congestive heart failure cause confusion or impaired memory?

Heart failure means cardiac output is low
Poor kidney perfusion so kidney function deteriorates
Metabolites normally removed reach brain

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What can cause heart failure?

Ischaemic heart disease
Hypertension
Viral?
Alcohol abuse (ETOH)

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What type of heart failiure is Left Ventricular systolic dysfunction?

Ejection problem (HFrEF)

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What type of heart failiure is Stiff Left Ventricular diastolic dysfunction?

Stiff heart muscle
Impaired ventricular filling
(HFpEF)

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What type of Heart failure can only receive symptomatic treatment (cant actually treat it)?

HFpEF

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What type of Heart failure can receive both symptomatic and prognostic treatment?

HFrEF

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What drug is a drug used to manage the symptoms of heart failure and is ALWAYS given in HF?

Furosemide

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What type of drug is furosemide?

Diuretic

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What is the function of Furosemide in the management of Heart failure?

Reduces water retention (more urine) so helps prevent fluid build up reducing hydrostatic pressure preventing congestion

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What prognostic drugs can be given to treat HFrEF heart failure?

Furosemide = Symptomatic (Diuretic)

ACE Inhibitor
Beta blocker
Mineralocorticoid receptor antagonist (Spironolactone) Aldosterone antagonist
Sacubitril valsartan

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What non drug methods can be done to treat Heart failure with reduced ejection fraction (HFrEF)?

Implantable cardioverter defibrillator
Biventricular pacemaker
Surgery to repair a faulty valve

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If a patients has:
-Sudden onset severe SOB
-No peripheral oedema
-No PMH
-No medication

Pulse: 130bpm
BP: 170/70mmHg
Loud heart murmur
RR: 40
PO2: 92%
-Profuse bilateral crepitations

What is the immediate treatment?

IV Furosemide 80mg stat
O2
Likely respiratory support
Second line IV nitrates, IV morphine

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On an ECG how can you detect left ventricular hypertrophy?

QRS complexes invades neighbouring leads traces

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If a patients has:
-Sudden onset severe SOB
-No peripheral oedema
-No PMH
-No medication

Pulse: 130bpm
BP: 170/70mmHg
Loud heart murmur
RR: 40
PO2: 92%
-Profuse bilateral crepitations

From an ECG the patient has LV hypertrophy, what is a possible cause of this hypertrophy?

Possibly aortic valve stenosis

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How is cardiomegaly visible on a CXR?

Cardiac outline is greater than 50% of the interthoracic space

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How can heart failures be viewed on a CXR?

Cardiomegaly
Pleural effusions
Kerley B lines

What are Kerley B lines?

Horizontal lines in lung periphery that extend to pleural surface

These indicate thickened oedematous interlobular septa due to pulmonary oedema

What effects does IV furosemide do to help treat heart failure?

Venodilatory effect
Diuretic effect

What can indicate left bundle branch block on an ECG?

Broader than normal QRS complex due to conduction taking longer

What can be used to treat left bundle branch block?

Biventricular pacemaker

What does a boot shaped heart on a CXR indicate?

Left ventricular aneurysm

What is left ventricular aneurysm?

Weakend area in the wall of the heart bulges/swells

What are 2 beta blockers that may be used to treat HFrEF?

Bisoprolol Carvedilol

Why are ACE inhibitors extremely important in treating HFrEF/how do they act?

Prevents Angiotensin I —> Angiotensin II Reduces cardiac workload

How do ACE inhibitors preventing production of Angiotensin II reduce workload of the heart in heart failure?

Angiotensin II stimulates ADH production by posterior pituitary = More water retained (If ACE Inhibitor less ADH = more water lost) Angiotensin II stimulates adrenal cortex to make more aldosterone = more Na+/K+ pumps in nephron more Na+ and water = more water retained in blood (if ACE inhibitor, less aldosterone so less Na+ and water in blood) Angiotensin II stimulates vasoconstriction increasing total BP (if ACE inhibitor blood vessels dilate)

How does less ADH being produced as a result of ACE inhibitors affect the heart in HFrEF?

Reduced blood vol = reduced preload

How does less Aldosterone being produced as a result of ACE inhibitors affect the heart in HFrEF?

Reduced blood volume = reduced preload

How does less vasoconstriction as a result of less being produced angiotensin IIas a result of ACE inhibitors affect the heart in HFrEF?

BP decreases due to vasodilation = reduced afterload

What blood test can be done to rule out Heart failure if its normal?

NTpro-BNP

What does NTpro-BNP assess ?

The likelihood of having HF (Higher = Higher)

When are natriuretic peptides released?

In response to atrial/ventricular stretch due to fluid overload

Why is U+E tests important in testing for HF?

Renal function deteriorates in HF due to the low cardiac output leading to poor perfusion of the kidneys

Why does Hyponatremia occur in Heart failure?

Lots of ADH made to increase water reabsorption to try and increase BP to inc CO. The increased water volume dilutes the Na+ content causing hyponatraemia

Why may Liver function tests be elevated in Heart failure?

Hepatic congestion

What drugs are important to consider with heart failure with atrial fibrillation?

Anticoagulants

What are the negative responses the body produces to heart failure?

Baroreceptor response tries to increase CO by +ve chronotropy and +ve inotropy RAAS activated due to decreased renal perfusion More fluid retention = inc preload

What are the good responses the body produces to heart failure?

Naturetic peptides

What is the function of naturetic peptides?

Make you excrete Na+ so more water removed in urine Also vasodilators Inhibits RAAS activity

What is a drug that stimulates Natriuretic peptide production and inhibits RAAS activity so is useful for treating HFrEF?

Sacubitril valsartan

What 3 things does the RAAS do in heart failure?

Vasoconstriction Salt and water retention Enchanced sympathetic activity (more adrenaline )

What 2 types of drugs can be give to affect the RAAS?

ACE inhibitor Angiotensin receptor blocker (prevents angiotensin II from binding)

What ACE inhibitors could be used for heart failure?

Ramipril Enalapril Captopril

How can the activation of sympathetic system in HF lead to further damage?

Increased heart rate and contractility —> inc myocardial oxygen demand —> eventually leads to decreased contracility

What are the long term negative effects of the sympathetic nervous system being active in HF?

B adrenergic receptors get down regulated so cant increase CO in excercise Inc cardiac hypertrophy Inc RAAS

What is the function of B blockers in HF?

Reduce heart rate (reduce myocardial O2 demand) Reduce BP (reduce myocardial O2 demand) Negate undesired effects of Catecholamines Reduce glycogen mobilisation

What is the function of Spironolactone?

Works on the RAAS Is an aldosterone receptor antagonist

Why is a biventricular pacemaker used in Left bundle branch block?`

Takes longer for LV to start contracting so the 2 ventricles contract at different times causing a rocking like motion