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Cardiology 2023 1MB > Heart Failure r: Cameron McCloskey > Flashcards

Heart Failure r: Cameron McCloskey Flashcards

1
Q

What may cause heart failure?

A
  • Coronary artery disease
  • Valvular heart disease
  • Arrhythmias
  • Cardiomyopathies
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2
Q

Name some causes of cardiac myopathy

A
  • Inherited - dilated cardiomayopathy
  • Thyrotoxicosis
  • Alcohol
  • Drugs - chemo agents
  • Pregnancy
  • Pericardial effusions
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3
Q

Right heart failue will cause congestion ____________

A

Systemically

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4
Q

Left heart failure will cause congestion in the ________

A

Lungs

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5
Q

Pulmonary oedema will lead to what?

A

Orthopnoea

Paroxysmal dyspnoea

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6
Q

Chronic right heart failure may lead to what?

A
  • Hepatomegaly
  • Ascities
  • GI distress
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7
Q

What is PND, and what causes it specifically?

A

Paroxysmal nocturnal dyspnoea

Left heart failure

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8
Q

Pulmonary oedema is associated with which type of sputum?

A

A cough with frothy sputum

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9
Q

What is orthopnoea and what sided heart failure is associated?

A

Breathlessness when lying flat

Left sided heart failure

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10
Q

Why does left sided heart failure often present with cyanosis?

A

Pulmonary oedema is often present which impairs gas exchange meaning oxygen cannot enter as easily into the bloodstream

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11
Q

Whta are signs of right sided heart failure?

A
  • Elevated JVP
  • 3rd heart sound - early systole caused by blood flowing quickly into a failing heart
  • Murmur
  • Peripheral oedema
  • Hepatomegaly
  • Ascities
  • Tachycardia
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12
Q

In relation to the different times during a heart cycle that heart failure can manifest, what are the two heart failure classifications?

A

Systolic - the heart fails to pump sufficiently

Diatolic - the heart fails to relax sufficiently - often as a result of hypertension

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13
Q

What are the two types of chronic heart failure?

A
  1. Compensated - stable - patient appears well and in control
  2. Decompensated - unstable
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14
Q

Blood pressure is often very ____ in patients with decompensated heart failure

A

Low

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15
Q

What investigations should be taken for suspected heart failure?

A
  • FBC
  • U+Es
  • LFTs
  • Lipids
  • Thyroid function
  • BNP - B-natriuretic peptide (not in Tayside)
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16
Q

What causes B-natriuretic peptide to rise?

A

Can be released due to atrial stretch

It is not specific to heart failure

Yet is is high in heart failure, so a normal result will rule out heart failure

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17
Q

Which tests should be done for suspected heart failure?

A
  • ABGs
  • ECG
  • CXR
  • ECHO
  • Troponin I - only when ACS is suspected
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18
Q

What can be seen on a CXR for heart failure?

A
  • Cardiomegaly
  • Alveolar oedema
  • Prominent upper lobe vessels
  • Kerley B lines
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19
Q

What is the gold standard investigation for heart failure?

A

ECHO

20
Q

What is the first step in treating heart failure?

A

Treat cause

  • Stop alcohol
  • Control AF
  • Valve replacement
  • Reduce BP
  • Revascularisation
21
Q

How may you treat a patient to make them feel better during heart failure?

A
  • Fluid balance
  • Diuretics if overloaded and breathless (furosemide)
22
Q

How can heart failure be treated pharmacologically to remove symptoms?

A
  • ACEI (or ARB)
  • Beta blocker
  • Aldosterone antagonist
23
Q

Which ACEI could be used to treat heart failure?

A
  • Lisinopril
  • Enalapril
24
Q

ACEI have what side effects?

A
  • Angioneurotic oedema (rapid swelling of the dermis, subcutaneous tissue, mucosa and submucosal tissues - similar to urticaria (hives))
  • Dry cough
  • Renal impairment
25
Q

Why are beta blockers used to treat heart failure?

A

They are used to “calm” to sympathetic influence on the heart

26
Q

Why should beta blockers be used only when heart failure has stabilised?

A

They reduce contractility so can worsen heart failure initially

27
Q

Which beta blockers may be used to treat heart failure?

A
  • Bisoprolol
  • Carvedilol
28
Q

Which drug class is used in moderate and severe heart failure?

A

Aldosterone antagonists

29
Q

Which aldosterone antagonists will be used to treat heart failure?

A
  • Spironolactone
  • Eplenerone
30
Q

What are the side effects of aldosterone antagonists?

A
  • Hyperkalaemia
  • Renal dysfunction
  • Gynaecomastia
31
Q

How can the side effect of gynnaecomastia be avoided when using spironolactone?

A

Switch to eplenerone instead

32
Q

Which drug is used when the beta blocker dose is at its maximum and the heart rate will still not reduce?

A

Ivabradine

33
Q

Which drug is set to replace ACEI in the future?

A

Sacubitril-valsartan

34
Q

How does cardiac resynchronisation therapy (CRT) work?

A

It involves the right atrium, right ventricle and left ventricle being stimulated in order for them to contract

This allows synchronisation between the RV and LV

(used in BBB for example)

35
Q

In acute heart failure how is treatment approached?

A

ABCDE

36
Q

Why are opiates used in acute HF?

A
  • They relax the patient
  • They venodilate
37
Q

Why are ntrates useful in acute HF?

A

Venodilatation

38
Q

why acute left-sided heart failure does not directly cause peripheral oedema, but does directly cause pulmonary oedema?

A

capillary hydrostatic force driving tissue fluid out of capillaries is reduced when aortic pressure decreases. By contrast, the failure of the left heart causes congestion of the lungs and an increased backpressure. Consequently, the pulmonary capillary pressure will increase due to the congestion of the pulmonary circulation.

39
Q

How would right heart failure can causes left heart failure ?

A

Sometimes left sided heart failure can lead to pulmonary congestion which in turn also pushes the right ventricle into failure. In these cases signs and symptoms of both left and right sided heart failure may be present.

40
Q

How would right heart failure can causes left heart failure ?

A

Sometimes left sided heart failure can lead to pulmonary congestion which in turn also pushes the right ventricle into failure. In these cases signs and symptoms of both left and right sided heart failure may be present.

41
Q

New York Heart Association Classification of Heart failure

A

I - no limitation

II- slight limitation Palpitation and or dyspnoea

III- comfort at risk

IV- Orthopnoea

42
Q

what is BNP

A

BNP>2000ng/L urgent two weeks referral and ECHO

If BNP 400-2000ng/L 6 week referral and ECHO

43
Q

type of blood test for CHEF and why we do them ?

A
  • U+Es to assess renal function (for medication) and to look for hyponatraemia
  • LFTs for hepatic congestion
  • TFTs to check for hyperthyroidism
  • Glucose and lipid profile to assess modifiable cardiovascular risk factors
    • BNP is significantly associated with a diagnosis of heart failuare
44
Q

X ray findings ABCDEF

A

Alveolar

Kerley B line

Cardiomegaly

upper limb diversion

Pleural effusion

Fluid in the horizontal fissure

45
Q

what are the drugs for CHEF to improve mortality

A

ACE and Beta

also

spironolactone or eplerenone. can improve mortality

46
Q

improve symptoms of patients with CHEF

A

furosemide or bumetanide . (hypocalcaemia )

47
Q

patient is presented with Class 3 or 4 NYHA consider

A

spironolactone or eplerenone.

Hydralazine and a nitrate

Ivabradine if in sinus rhythm and impaired ejection fraction

Angiotensin receptor blocker ARB

Digoxin

Cardiology 2023 1MB (28 decks)

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