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Cardiovascular System > Heart Failure Presentation and Investigations > Flashcards

Heart Failure Presentation and Investigations Flashcards

1
Q

Definition of Heart Failure

A

a clinical syndrome comprising of dyspnoea, fatigue or fluid retention due to cardiac dysfunction, either at rest or on exertion, with accompanying neurohormonal activation

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2
Q

What is neurohormonal activation

A

Defence mechanisms designed to preserve arterial volume and circulatory homeostasis during periods of low cardiac output. This includes the sympathetic system, RAAS and vasopressin

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3
Q

Is HF the final diagnosis? why

A

No, needs to qualified by the underlying structural abnormality

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4
Q

Increasing risk of CHF (7)

A 
	Treatment of AMI
	Ageing population
	Hypertension
	CHD
	Obesity
	Diabetes
	HLP
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5
Q

Decreasing risk of CHF (6)

A 
	HLP
	Hypertension
	CHD
	Diabetes
	Obesity
	Treatment of CHF
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6
Q

What group of diseases does HF have a similar mortality to?

A

Cancers

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7
Q

Heart Failure Hospital Admissions (8)

A
  1. Acute breathlessness
  2. Stable HF
  3. Acute MI/unstable angina
  4. Rapid atrial fibrillation
  5. Asymptomatic cardiac dysfunction
  6. Ventricular arrhythmia
  7. Cardiogenic shock
  8. Cardiac arrest
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8
Q

What 3 things are needed for a diagnosis

A
  1. Symptoms or signs of HF
  2. Objective evidence of cardiac dysfunction
  3. Response to therapy (diuretics)
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9
Q

Symptoms of HF (4)

A
  • Breathlessness
  • Fatigues
  • Oedema
  • Reduced exercise capacity
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10
Q

Signs of HF (6)

A
  • Oedema
  • Tachycardia
  • Raised JVP
  • Chest crepitations
  • 3rd heart sound
  • Displaced or abnormal apex beat
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11
Q

What would a CXR show in HF (4)

A
  • Cardiomegaly
  • Dilation of vessels due to pressure
  • Increased cardiothoracic ratio
  • Pleural effusions
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12
Q

Objective evidence of cardiac dysfunction

A
  • ECHO
  • Radionucleotide Scan
  • Left ventriculogram
  • Cardiac MRI
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13
Q

Potential Screening tests

A
  • 12 lead ECG

* BNP (brain (B-type) natriuretic peptide)

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14
Q

if 12 lead ECG is normal what is very unlikely

A

LVSD

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15
Q

BNP is elevated/reduced in heart failure?

A

Elevated

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16
Q

What are the other reasons BNP can be elevated

A
  • AF
  • Elderly
  • Valve Disease
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17
Q

Diagnostic evaluation of patients with LVSD (8)

A
  1. Detailed history
  2. Exclude renal failure, anaemia
  3. Autoantibodies/viral serology, ferritin levels
  4. Exclude pheochromocytoma (neuroendocrine tumour of the medulla of the adrenal glands)
  5. ECG, CXR, always do ECHO
  6. Consider coronary angiogram if there is chest pain in younger patients
  7. Evaluate for ischaemia/hibernation
  8. Cardiac MRI
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18
Q

Why is an ECHO essential (7)

A 
•	Identify and quantify
	LV systolic dysfunction
	Valvular dysfunction
	Pericardial effusion/tamponade
	Diastolic dysfunction
	LVH
	Atrial/ventricular shunts/complex congenital heart defects
	Pulmonary hypertension/right heart dysfunction
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19
Q

What may a ECHO not idnetify

A

Constriction

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20
Q

Biological variable

A

LVEF

21
Q

What can decrease and increase the LVeF

A

Disease and physiological changes

22
Q

Why can LVEF be difficult to quantify accurately using ECHO (^)

A 
•	Quality of images
•	Experience of operator
•	Calculation method
	M-mode
	Simpson’s biplane
•	Use of contrast agents
•	Time consuming to perform
•	Normal range is centre specific, but LVEF not routinely measured
23
Q

LVEF 50-80%

A

Normal

24
Q

LVEF 20-50%

A

Mild

25
Q

LVEF 30-40%

A

Moderate

26
Q

LVEF <30%

A

Severe

27
Q

Biplane Modified Simpson’s Rule

A

Divides LV cavity into multiple slices of known diameter and thickness

28
Q

Biplane Modified Simpson’s Rule- Volume of each slice =

A

area x thickness (πr2 x thickness)

29
Q

Biplane Modified Simpson’s Rule- thinner slices mean

A

More accurate volume estimate

30
Q

Left ventricle ejection fraction depends on

A

LV contractility, pre-load, afterload and HR

31
Q

LVEF =

A

EDV-ESV/EDV

32
Q

Pros of MUGA for LVEF (2)

A

Can obtain accurate figure

Greater reproducibility

33
Q

Cons of MUGA for LVEF (2)

A

Ionising radiation

No additional structural information

34
Q

Pros of MRI for LVEF (3)

A

Gold standard
Reproducible
Added information about- fibrosis,oedema, infiltration and valves

35
Q

Cons of MRI for LVEF (3)

A

Time consuming
Dependent on patient compliance
Specialist centres
Long waiting lists

36
Q

NYHA class I Heart Failure exercise tolerance and symptoms

A

No limitation

No symptoms during usual activity

37
Q

NYHA Class II Heart Failure exercise tolerance and symptoms

A

Mild limitation

Comfortable with rest or mild exertion

38
Q

NYHA class III heart failure exercise tolerance and symptoms

A

Moderate limitation

Comfortable only at rest

39
Q

NYHA class IIII exercise heart failure tolerance and symptoms

A

Severe limitations

Any physical activity brings on discomfort and symptoms occur at rest

40
Q

Does HF equal reduced CO (YN)

A

No

41
Q

In a normal heart if the EDV is 100mls with 60% EF and a HR of 60bpm what is the CO

A

CO= SV X HR
60% of 100mls = 60mls (SV)
60mls X 60bpm= 3600ml
3.6 Litres

42
Q

In a dilated heart if the EDV is 200ml with only 30% EF and a HR of 60bpm what is the CO

A

CO= SV X HR
30% of 200mls = 60mls
60mls X 60bpm = 3.6 Litres

43
Q

Modern Pharmacological Treatment of Heart Failure (6)

A 
Diuretics
ACEI/ARB
B Blockers
Aldosterone receptor blockers
ARNIs
44
Q

Diuretics

A

-Furosemide/Bumetanide

45
Q

ACEI/ARB

A
  • Ramipril, Enalapril

- Candesartan/Valsartan

46
Q

B Blockers

A

-Carvedilol/Bisoprolol

47
Q

Aldosterone receptor blockers

A

Spironolactone/Eplerenone

48
Q

ARNIs

A

-Entresto

Cardiovascular System (42 decks)

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