HF Flashcards
Pathophysiology
Inability of the heart to achieve adequate cardiac output
Presentation
SOB
Fatigue
Right:
- peripheral oedema (pitting)
- raised JVP
- hepatomegaly
Left:
- pulmonary crackles
- PND
- orthopnoea
- displaced apex beat - cardiomegaly
Risk factors
IHD - commonest cause
Coronary artery disease
Previous MI
Valvular heart disease
Chronic lung disease - cor pulmonale
HTN
AF
DM
Family history
Investigations
Basic obs
Bloods- BNP, FBC, U+Es, LFTs, CRP, Trop I, lipids, HbA1c
ECG
CXR
Echocardiogram - EF
BNP
400+
BNP may be reduced by
BMI
diuretics
ACEi
Beta blockers
Aldosterone
African Caribbean
BNP may be elevated by
70+ yo
LVH, MI
Hypoxia
Pulmonary hypertension
PE
Sepsis
COPD
DM
Liver cirrhosis
Ejection fraction calculation
SV/EDV
Ejection fraction percentages
Normal - 50% +
HFrEF - less than 40%
Management
Loop diuretic - furosemide +
1. ACEi/ARB + Beta blocker - started 1 at a time
2.Spironolactone
3. Digoxin
NYHA classification
I - no limitation of physical activity
II - some limitation with physical activity relieved by rest
III - breathless with minor activity relieved by rest
IV - breathless at rest
Acute management of pulmonary oedema
Sit upright
Oxygen if required
Diamorphine - decrease tachypnoea
Furosemide
GTN
May need CPAP
- treat precipitating cause e.g. MI
- manage fluid overload - fluid restriction and furosemide
Loop diuretic monitoring
Monitor renal function
Weight
CXR findings (ABCDE)
- alveolar oedema - bat wing sign
- Kerley B lines
- cardiomegaly
- dilated upper lobe blood vessels
- pleural effusion
End stage HF
High risk of dying within 6 - 12 months
What does BNP do
- Promotes Na+ excretion which takes water with it to decrease blood pressure.
- causes vasodilation of afferent arteriole
- synthesised and stored in atrial myocytes
- released in response to atrial stretch
ECG signs
Ischaemia
Hypertrophy
AF
Conservative Mx
Stop smoking
↓ salt intake
Optimise weight - dietician
Supervised group exercised based rehab programme
Digoxin
Enhances vagal activity
Increases K+ efflux
Decreases Ca2+ influx
Signs of pulmonary oedema
Distressed, sweaty, cyanosed
↑HR, ↑RR
↑JVP
S3
Bibasal creps
Pleural effusions
Wheeze
Symptoms of pulmonary oedema
Dyspnoea
Orthopnoea
Pink frothy sputum
PND
Third line drugs for HF
Ivabradine
- inhibits funny currents
- sinus rhythm > 75/min and LV fraction < 35%
Sacubitril valsartan
- LV fraction < 35%
- if symptomatic on ACEi
Digoxin
- no proven benefit on mortality
- symptomatic relief by inhibiting Na+/K+ ATPase
- used if also have AF
Hydralazine
- if Afro - Caribbean
Cardiac desynchronisation therapy
- if broad complex QRS - LBBB
Vaccinations
Annual influenza
One off pneumococcal
