HF Flashcards
Define HF
Cardiac output inadequate for requirements
what is the incidence of HF
1-3% but 10% in elderly
what is the 5 year survival for HF
25-50%
what are the causes of HF
- IHD 70% , Hypertension (5%)
- Non-Ischaemic Dilated Cardiomyopathy (25%)
- Other: valvular, congenital (VSD, ASD), AF, PE
what is the aetiological difference between mild, moderate and severe HF
Mild: ↓EF →↓CO and ↑HR
Moderate: ↑ venous pressure +↑HR= ↓CO
Severe: ↓CO even at rest
what is the cycle of heart failure
increased pre-load leads to increased cardiac work/myocardial damage leads to decreased CO which leads to RAAS activation that causes vasoconstriction and water retention leading to increased pre-load
Define congested HF
combination of L and F HF
define Systolic HF
: Ejection Fraction (EF)
define diastolic HF
: ↑ filling pressure with EF>50% i.e. tamponade HTN,
define High output HF
↑demand i.e. anaemia, pregnancy
define low output HF
failure to maintain CO
what are the main causes of Left HF
- IHD,
- Non-ischaemic dilated cardiomyopathy
- Hypertension
- Valvular: MS(HTN in RA)
what are the symptoms of L HF
- Fatigue (common)
- Exertional dyspnoea
- Orthopnoea / PND
what are the signs of L HF
- Apex displacement: cardiomegaly
- 3rd heart sound: galop rhythm
- Crackles in lung bases: Pulmonary oedema
- Pitting oedema
what are the causes of R HF
- Cor pulmonalis
- PE, pulmonary hypertension
- Tricuspid OR pulmonary valve disease
- ASD, VSD
- RV cardiomyopathy
what are the symptoms of R HF
• Fatigue, dyspnoea, anorexia, nausea
what are the signs of R HF
- ↑JVP
- Cardiomegaly and functional tricuspid regerge
- Hepatomegaly and ascitic
- Pitting oedema
what bloods would be useful in diagnosis of HF and why
↑BMP, FBC(anaemia), U&E (eGFR, ion stability), CVS ↑risk: Glucose (DM) Lipids, TFTs, LFTs (liver ascitis?)
What other investigations are useful in assessing HF and why
• CXR: cardiomegaly, pleural effusion
• ECGO if BMP >400pg/ml
o LV function, valves diastolic function
what factors other than HF raise naturetic peptide
o Chronic hypoxaemia o Renal dysfunction o Advanced age o Liver cirrhosis o Sepsis
What level on naturetic peptide warrens ECHO
> 100pm/ml
what is the NYHM scale of HF
classification of disability due to HF
what is class I NYHA
No limitation of physical activity
what is class II NYHA
Slight limitation of physical activity (symptomatically mild heart failure
what is class III NYHA
Marked limitation of physical activity (symptomatically moderate heart failure)
what is class IV NYHA
Symptoms at rest (symptomatically severe heart failure)
What lifestyle changes are recommended in HF
- ↑exercise, ↓salt, stop smoking & alcohol
- Travel advice
- Cardiac rehab
What medications are people with HF expected to be taking
- Diuretics: 1st lien furosemide (40mg); 2nd line bumetanide 3rd line add thiazide
- ACEi & β-blocker: LVEF
what is the specific management of LVHF
- ACEi and β-blocker
- Replace ACEi with ARB 2nd line
- Specialist
a. Spirolactone
b. Digoxin=> sever HF
what are the Surgical management options for HF
- Revisualisation: due to angina
* Devices: pacemaker (CRT) and defibrillator (ICD)
what is the palliative management in HF
- Treat/prevent co-morbidities
- Good nutrition/allow alcohol
- Control: Dyspnoea, Pain => from liver capsule stretching, Nausea, Constipation, ↓mood/depression
what is the management of acute HF
- ABCDE: Oxygen
* Diuretics, β-blockers, ACEis
