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CVS > Heart Failure Investigations And Management > Flashcards

Heart Failure Investigations And Management Flashcards

1
Q

What is NYHA?

A

A measure of Breathlessness

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2
Q

What is Class I of Heart Failure on NYHA?

A

Class I: No symptomatic limitation of physical activity

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3
Q

What is Class II of Heart Failure on NYHA?

A

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

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4
Q

What is Class III of Heart Failure on NYHA?

A

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

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5
Q

What is Class IV of Heart Failure on NYHA?

A

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

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6
Q

What are some symptoms of heart failure?

A

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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7
Q

Why can congestive heart failure cause confusion or impaired memory?

A

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

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8
Q

What can cause heart failure?

A

Ischaemic heart disease
Hypertension
Viral?
Alcohol abuse (ETOH)

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9
Q

What type of heart failiure is Left Ventricular systolic dysfunction?

A

Ejection problem (HFrEF)

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10
Q

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

A

Stiff heart muscle
Impaired ventricular filling
(HFpEF)

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11
Q

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

A

HFpEF

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12
Q

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

A

HFrEF

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13
Q

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

A

Furosemide

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14
Q

What type of drug is furosemide?

A

Diuretic

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15
Q

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

A

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

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16
Q

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

A

Furosemide = Symptomatic (Diuretic)

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

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17
Q

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

A

Implantable cardioverter defibrillator
Biventricular pacemaker
Surgery to repair a faulty valve

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18
Q

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?

A

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

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19
Q

On an ECG how can you detect left ventricular hypertrophy?

A

QRS complexes invades neighbouring leads traces

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20
Q

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?

A

Possibly aortic valve stenosis

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21
Q

How is cardiomegaly visible on a CXR?

A

Cardiac outline is greater than 50% of the interthoracic space

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22
Q

How can heart failures be viewed on a CXR?

A

Cardiomegaly
Pleural effusions
Kerley B lines

23
Q

What are Kerley B lines?

A

Horizontal lines in lung periphery that extend to pleural surface

These indicate thickened oedematous interlobular septa due to pulmonary oedema

24
Q

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

A

Venodilatory effect
Diuretic effect

25
Q

What can indicate left bundle branch block on an ECG?

A

Broader than normal QRS complex due to conduction taking longer

26
Q

What can be used to treat left bundle branch block?

A

Biventricular pacemaker

27
Q

What does a boot shaped heart on a CXR indicate?

A

Left ventricular aneurysm

28
Q

What is left ventricular aneurysm?

A

Weakend area in the wall of the heart bulges/swells

29
Q

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

A

Bisoprolol
Carvedilol

30
Q

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

A

Prevents Angiotensin I —> Angiotensin II
Reduces cardiac workload

31
Q

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

A

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)

32
Q

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

A

Reduced blood vol = reduced preload

33
Q

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

A

Reduced blood volume = reduced preload

34
Q

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

A

BP decreases due to vasodilation = reduced afterload

35
Q

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

A

NTpro-BNP

36
Q

What does NTpro-BNP assess ?

A

The likelihood of having HF (Higher = Higher)

37
Q

When are natriuretic peptides released?

A

In response to atrial/ventricular stretch due to fluid overload

38
Q

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

A

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

39
Q

Why does Hyponatremia occur in Heart failure?

A

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

40
Q

Why may Liver function tests be elevated in Heart failure?

A

Hepatic congestion

41
Q

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

A

Anticoagulants

42
Q

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

A

Baroreceptor response tries to increase CO by +ve chronotropy and +ve inotropy

RAAS activated due to decreased renal perfusion
More fluid retention = inc preload

43
Q

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

A

Naturetic peptides

44
Q

What is the function of naturetic peptides?

A

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

45
Q

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

A

Sacubitril valsartan

46
Q

What 3 things does the RAAS do in heart failure?

A

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

47
Q

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

A

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

48
Q

What ACE inhibitors could be used for heart failure?

A

Ramipril
Enalapril
Captopril

49
Q

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

A

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

50
Q

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

A

B adrenergic receptors get down regulated so cant increase CO in excercise

Inc cardiac hypertrophy
Inc RAAS

51
Q

What is the function of B blockers in HF?

A

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

52
Q

What is the function of Spironolactone?

A

Works on the RAAS
Is an aldosterone receptor antagonist

53
Q

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

A

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

CVS (21 decks)

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