Heart Failure Investigations And Management Flashcards
What is NYHA?
A measure of Breathlessness
What is Class I of Heart Failure on NYHA?
Class I: No symptomatic limitation of physical activity
What is Class II of Heart Failure on NYHA?
Class II: Slight limitation of physical activity, no symptoms at rest
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
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
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
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
What can cause heart failure?
Ischaemic heart disease
Hypertension
Viral?
Alcohol abuse (ETOH)
What type of heart failiure is Left Ventricular systolic dysfunction?
Ejection problem (HFrEF)
What type of heart failiure is Stiff Left Ventricular diastolic dysfunction?
Stiff heart muscle
Impaired ventricular filling
(HFpEF)
What type of Heart failure can only receive symptomatic treatment (cant actually treat it)?
HFpEF
What type of Heart failure can receive both symptomatic and prognostic treatment?
HFrEF
What drug is a drug used to manage the symptoms of heart failure and is ALWAYS given in HF?
Furosemide
What type of drug is furosemide?
Diuretic
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
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
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
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
On an ECG how can you detect left ventricular hypertrophy?
QRS complexes invades neighbouring leads traces
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
How is cardiomegaly visible on a CXR?
Cardiac outline is greater than 50% of the interthoracic space
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
