Heart Failure - Presentation & Investigation Flashcards
What pathologies define heart failure?
- LVSD/LVF
- RVF
- reduced/increased CO
What are the factors that are contributing to the increase in prevalence of heart failure?
- treatment of acute MI/increased risk of developing CHF.
- ageing population
- better management of co-morbidities, increased likelihood of CHF
What are the symptoms of congestive heart failure?
4
- orthodyspnoea
- paroxysmal nocturnal dyspnoea
- cough with pink sputum
- breathless on exertion
What are the clinical signs of CHF?
5
- peripheral oedema
- raised JVP
- murmurs/S3 gallop
- displaced apex beat
- tachycardia
- crepitations/pleural effusion
What imagery techniques might be used in investigating CHF?
4
- ECHO/contrast
- cardiac MRI
- L ventriculogram
- CT coronary angiogram (rule out)
What are the main investigations carried out when investigating for CHF?
- ECG
- Bloods
- ECHO
- CXR
What bloods might you want to request?
What would be the main one of interest?
- U&Es (renal function)
- LFT
- lipid profile
- FBC
- TFT
- BNP
BNP - increased in CHF
If the BNP blood test came back negative, what could be deduced from this?
- CHF ruled out
- consider other diagnosis for the symptoms
If BNP test came back positive, what would be the next step?
- CHF likely
- carry out ECHO
What are the two investigations that can be carried out for screening for congestive heart failure?
- 12 lead ECG
- BNP blood test
What can an increase in blood BNP also be due to?
5
hypertension renal impairment arrhythmia (AF) valvular heart disease elderly
What information would you be hopeful to gather from a history when considering CHF?
- previous MI/CAD
- previous hypertension
- diuretic use
- Fx
- Hx of orthopnoea/PND
What observations can be picked up from a CXR which point to CHF?
(5)
ABCDE
Alveolar (pulm. oedema) Kerley B lines Cardiomegaly Upper lobe vessel dilation Pleural effusion
What is the order of investigations and examination for the for the diagnosis of heart failure?
- symptoms/signs of CHF
- Bloods inc. BNP/ECG
- if BNP elevated or ECG abnormal: ECHO (if normal - consider diagnosis other than CHF)
What are the structural causes of heart failure?
4
- LVSD (HF)
- Valvular heart disease
- Pericardial constriction/effusion
- LVDD/heart failure with normal ejection fraction
- RVF: pulmonary hypertension
What is the main causes of left ventricular systolic dysfunction (LVSD)?
- IHD (usually MI)
- Severe AS/MR
- Dilated cardiomyopathy (DCM) i.e. LVSD not due to IHD
- hypertension
- arrhythmias
What is echocardiography used to determine in CHF?
6
Identify and quantify the cause of LVSD:
- valvular disease
- pericardial effusion/tamponade
- LVDD
- LVH
- Congenital heart defects (e.g. VSD)
- RVF/pulmonary hypertension
What is a normal LV ejection fraction?
55-70%
What is the ejection fraction for severe cardiac failure?
<30%
What are the techniques used to calculate LVEF on ECHO?
2
M-mode
Simpson’s biplane
What are the investigations done to assess LVEF?
ECHO
MUGA (ionising radiation)
cardiac MRI -gold standard
How would you describe the cardiac output in heart failure?
It can be both decreased and increased, due to increased afterload and preload, respectively.
Outline the drug classes used to treat heart failure.
ACE inhibitor/ARB
Beta blocker
Diuretics
Aldosterone antagonist
Give examples of ACE inhibitors used. (2)
Ramipril
Enalapril
What are the only beta blockers licensed for use in UK currently?
bisoprolol
carvedilol
Give examples of suitable ARBs (used when ACEi are contraindicated). (2)
Candesartan
Valsartan
Give examples of aldosterone antagonists used. (2)
spironolactone
eplerenone
Give examples of diuretics commonly used. (2)
furosemide
bumetanide
What is ARNI?
new drug (e.g. entresto) combination of ARB/neprilysin
