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Cardiovascular System > Heart Failure - Presentation & Investigation > Flashcards

Heart Failure - Presentation & Investigation Flashcards

1
Q

What pathologies define heart failure?

A
  • LVSD/LVF
  • RVF
  • reduced/increased CO
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2
Q

What are the factors that are contributing to the increase in prevalence of heart failure?

A
  • treatment of acute MI/increased risk of developing CHF.
  • ageing population
  • better management of co-morbidities, increased likelihood of CHF
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3
Q

What are the symptoms of congestive heart failure?

4

A
  • orthodyspnoea
  • paroxysmal nocturnal dyspnoea
  • cough with pink sputum
  • breathless on exertion
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4
Q

What are the clinical signs of CHF?

5

A
  • peripheral oedema
  • raised JVP
  • murmurs/S3 gallop
  • displaced apex beat
  • tachycardia
  • crepitations/pleural effusion
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5
Q

What imagery techniques might be used in investigating CHF?

4

A
  • ECHO/contrast
  • cardiac MRI
  • L ventriculogram
  • CT coronary angiogram (rule out)
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6
Q

What are the main investigations carried out when investigating for CHF?

A
  • ECG
  • Bloods
  • ECHO
  • CXR
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7
Q

What bloods might you want to request?

What would be the main one of interest?

A
  • U&Es (renal function)
  • LFT
  • lipid profile
  • FBC
  • TFT
  • BNP

BNP - increased in CHF

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8
Q

If the BNP blood test came back negative, what could be deduced from this?

A
  • CHF ruled out

- consider other diagnosis for the symptoms

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9
Q

If BNP test came back positive, what would be the next step?

A
  • CHF likely

- carry out ECHO

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10
Q

What are the two investigations that can be carried out for screening for congestive heart failure?

A
  • 12 lead ECG

- BNP blood test

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11
Q

What can an increase in blood BNP also be due to?

5

A 
hypertension
renal impairment
arrhythmia (AF)
valvular heart disease
elderly
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12
Q

What information would you be hopeful to gather from a history when considering CHF?

A
  • previous MI/CAD
  • previous hypertension
  • diuretic use
  • Fx
  • Hx of orthopnoea/PND
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13
Q

What observations can be picked up from a CXR which point to CHF?

(5)

A

ABCDE

Alveolar (pulm. oedema)
Kerley B lines
Cardiomegaly
Upper lobe vessel dilation
Pleural effusion
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14
Q

What is the order of investigations and examination for the for the diagnosis of heart failure?

A
  1. symptoms/signs of CHF
  2. Bloods inc. BNP/ECG
  3. if BNP elevated or ECG abnormal: ECHO (if normal - consider diagnosis other than CHF)
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15
Q

What are the structural causes of heart failure?

4

A
  • LVSD (HF)
  • Valvular heart disease
  • Pericardial constriction/effusion
  • LVDD/heart failure with normal ejection fraction
  • RVF: pulmonary hypertension
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16
Q

What is the main causes of left ventricular systolic dysfunction (LVSD)?

A
  • IHD (usually MI)
  • Severe AS/MR
  • Dilated cardiomyopathy (DCM) i.e. LVSD not due to IHD
  • hypertension
  • arrhythmias
17
Q

What is echocardiography used to determine in CHF?

6

A

Identify and quantify the cause of LVSD:

  • valvular disease
  • pericardial effusion/tamponade
  • LVDD
  • LVH
  • Congenital heart defects (e.g. VSD)
  • RVF/pulmonary hypertension
18
Q

What is a normal LV ejection fraction?

A

55-70%

19
Q

What is the ejection fraction for severe cardiac failure?

A

<30%

20
Q

What are the techniques used to calculate LVEF on ECHO?

2

A

M-mode

Simpson’s biplane

21
Q

What are the investigations done to assess LVEF?

A

ECHO
MUGA (ionising radiation)
cardiac MRI -gold standard

22
Q

How would you describe the cardiac output in heart failure?

A

It can be both decreased and increased, due to increased afterload and preload, respectively.

23
Q

Outline the drug classes used to treat heart failure.

A

ACE inhibitor/ARB
Beta blocker
Diuretics
Aldosterone antagonist

24
Q

Give examples of ACE inhibitors used. (2)

A

Ramipril

Enalapril

25
Q

What are the only beta blockers licensed for use in UK currently?

A

bisoprolol

carvedilol

26
Q

Give examples of suitable ARBs (used when ACEi are contraindicated). (2)

A

Candesartan

Valsartan

27
Q

Give examples of aldosterone antagonists used. (2)

A

spironolactone

eplerenone

28
Q

Give examples of diuretics commonly used. (2)

A

furosemide

bumetanide

29
Q

What is ARNI?

A 
new drug (e.g. entresto)
combination of ARB/neprilysin

Cardiovascular System (37 decks)

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