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Cardiovascular System > Heart Failure, Oedema and Infective Endocarditis > Flashcards

Heart Failure, Oedema and Infective Endocarditis Flashcards

1
Q

What is heart failure?

A

A condition caused by cardiac dysfunction and resulting in dyspnoea, fatigue and the inability to do exercise

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2
Q

How can heart failure diagnosis be made with confidence?

A

Clinical history/exam
+ evidence of cardiac dysfunction
(+ response to diuretics)

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3
Q

What examinations should be carried out to assess cardiac dysfunction in heart failure?

A

Echocardiogram
Ventriculogram
Cardiac MRI
Radionuclide imaging

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4
Q

What are some potential causes of heart failure?

A 
Many severe structural diseases:
LV systolic/diastolic dysfunction
RV failure  
Valve disease
Myocarditis
Pericardial restriction 
Restrictive cardiomyopathy
Arrhythmias
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5
Q

What tests should be done to screen for heart failure?

A

12 lead ECG

Blood test for BNP levels

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6
Q

With that investigations can LV dysfunction be diagnosed?

A 
Thorough history 
ECG
CXR
Echo
CT/coronary angiogram
Blood tests (FBC, U&E, glucose, BNP)
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7
Q

What can cause LV systolic dysfunction?

A

Dilated cardiomyopathy
Infarction (MI)
Severe valve disease

bacterial/viral infections
Toxins
IVDA
Systemic diseases 
Hypertension
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8
Q

What is the prognosis for heart failure?

A

Poor, only 58% are alive within 5 years.

30-40% mortality at 1 year

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9
Q

How is heart failure classified?

A

Depending on severity of symptoms. Worse prognosis for worse stage

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10
Q

What is the common treatment for heart failure?

A

Diuretics
ACE inhibitors (or ARB’s)
Beta blockers
Aldosterone receptor blockers

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11
Q

What are some common symptoms of heart failure?

A 
Shortness of breath (rest/exertion)
Fatigue
Inability to do exercise
Leg swelling 
Orthopnea/PND
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12
Q

What are some signs of heart failure?

A 
Tachycardia 
Raised JVP
Crackles on auscultation
Displaced apex beat
Third heart sound
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13
Q

What is the prevalence of heart failure?

A

Affects 1-2% of the population in the UK

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14
Q

Are heart failure patients likely to be readmitted after an emergency admission?

A

Yes, most likely in the first 3 months

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15
Q

What is Sympson’s biplane rule?

A

A measure for calculating LV ejection fraction from an echocardiogram

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16
Q

How can LVEF be measured in heart failure patients?

A

Echocardiogram
MUGA (ventriculogram)
Cardiac MRI

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17
Q

What are the main risk factors for heart failure?

A 
Hypertension
IHD (coronary disease)
Alcohol
Diabetes
Valve disease
Congenital defects
Viral infections
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18
Q

What is the main system involved in heart failure, and what are its implications?

A

RAAS system
It’s activated by the reduction in LV ejection fraction causing lower cardiac output
This causes water/salt retention to increase BP and blood volume, which in turn puts more strain on the heart

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19
Q

What is the number one risk factor for heart failure?

A

Hypertension

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20
Q

What are the aims of heart failure treatment?

A

Improve survival

Reduce symptoms

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21
Q

What are the main therapeutic options in heart failure to reduce detrimental neurohormonal effects (RAAS activation)?

A

ACEi (ramipril)
ARB (valsartan)
Beta blockers (bisoprolol)

22
Q

What are the main therapeutic options in heart failure to improve beneficial neurohormonal effects (ANP/BNP)?

A

ARNI’s (valsartan+sacubitril)

Neprolysin (sacubitril)

23
Q

Why should ANP/BNP be stimulated in heart failure?

A

Because it promotes water and salt excretion and vasodilation
Opposite effect of RAAS

24
Q

Why should the RAAS be inhibited in heart failure?

A

Because it causes a reaction to the reduced cardiac output which causes higher blood volume (higher preload) and puts even more strain on the heart

25
Q

What are the main therapeutic options in heart failure to reduce symptoms?

A

Diuretics (furosemide +/- thiazides)

26
Q

What are the main therapeutic options in heart failure to improve the contractility of the heart?

A

Positive inotropes: Digoxin
Isorbate mononitrate or dinitrate
Ivabradine: slows heart rate (only give if BPM>70)

27
Q

When should beta blockers be given to a patient with heart failure?

A

Once/if they are stable. Don’t give in acute circumstances as their sympathetic drive is the only thing keeping them alive

28
Q

What are some disadvantages of using diuretics in heart failure?

A 
Can cause: 
hypotension
Low K+ and Na+
Dehydration
Gout
Increased levels of other drugs in the body (toxicity)
29
Q

What types drugs should be closely monitored when putting a patient with heart failure on diuretics? Give some examples

A 
Narrow therapeutic index drugs:
Gentamicin/vancomycin 
Lithium 
NSAIDs
Digoxin
30
Q

What are some disadvantages of ACEi in heart failure?

A

Doesn’t block alternative angiotensin pathways

Can cause:
First dose hypotension
Angioedema (afrocaribbeans)
Cough 
Hypotension 
Kidney damage
31
Q

What drug-drug interaction is important when giving elderly patients ACEi?

A

NSAIDs

32
Q

What other way can angiotensin I be converted into angiotensin II?

A

Chymase pathway

33
Q

Which receptor is blocked by angiotensin receptor blockers?

A

AT1

34
Q

What are the main three physiological aims of heart failure treatment?

A

Decrease RAAS activation
Increase ANP/BNP action
Improve cardiac function

35
Q

What is the combined action of ARNIs in heart failure?

A

Valsartan - stops angiotensin II conversion

Sacubitril - prevents ANP/BNP breakdown

36
Q

Why would warfarin be given to heart failure patients?

A

To prevent clots forming in dilated LV from the ineffective pumping of blood out of the heart

37
Q

What are risk factors for native valve Infective endocarditis (IE)?

A 
Rheumatic heart disease 
Mitral valve disease (prolapse)
Degenerative heart disease 
Congenital heart disease 
Indwelling medical devices 
Alcoholism 
Diabetes
IVDA
Immunocompromised
38
Q

What are the mechanisms of infection in IE?

A

Through mechanical damage -> exposure of extra cellular proteins -> inflammation (NBTE)
Inflammation -> integrins which bind to fibronectin on organism -> organism adheres to inflamed area

39
Q

How would bacteria enter the bloodstream to adhere to the inflamed endocardium in IE?

A

Medical procedures
Dental procedures
Extra cardiac infections
Poor dental hygiene

40
Q

What are some common symptoms of IE?

A

Fever
Weight loss, malaise, fatigue
Headache, arthalgia, weakness

41
Q

What are some common signs of IE?

A

Skin lesions: Janeway lesions, Olsen nodes, cutaneous infarcts, petechial rash, septic emboli
Eyes: Roth spots
Nails: splinter haemorrhages
Neurological/meningeal signs

42
Q

What investigations should be done to diagnose IE?

A 
Blood cultures (3x, 30 mins apart)
Blood test: FBC, CRP, ESR, U&E 
CXR
Urinalysis 
echocardiogram
PET or SPECT
Cardiac MRI
43
Q

What criteria are used for diagnosing IE?

A

Modified Duke criteria

44
Q

What are the major criteria for IE diagnosis?

A
  1. Positive blood cultures (>2, 12 hours apart, causative organisms)
  2. Abnormal imaging tests
45
Q

What are some of the causative agents for IE?

A 
Strep viridans
Strep bovis
Enterococci
Staph aureus
Coxiella Burnetii
Fungi 
HACEK gram -ve group
46
Q

What is the treatment of IE?

A

IV antibiotics
Ampicillin/flucloxacillin
Gentamicin/vancomycin
Rifampicin

47
Q

What complications could arise from IE and may call for surgery?

A

Heart failure
Uncontrolled infection
Risk of systemic embolisation (PE, CVA)

48
Q

What are possible prevention methods for IE?

A
  • Prophylactic antibiotics for high risk patients during high risk procedures
  • Effective dental hygiene/check ups
  • infection control
  • aseptic techniques
49
Q

What are the minor Duke criteria for IE diagnosis?

A
  • Predisposing factors
  • Fever
  • Vascular signs
  • Immunological signs
  • Microbiological evidence
50
Q

What is the prevalence of IE?

A

3-10 in 100,000 people
Men > women
Women worse prognosis

Cardiovascular System (8 decks)

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