ILA 1 - Broken heart: Flashcards
What investigations should be performed in those with suspected HF?
Suspected HF + MI Hx - Urgent transthoracic doppler 2D echo
Suspected HF + BNP >400pg/ml - Urgent transthoracic doppler 2D echo
Suspected HF + no MI Hx - measure serum BNP, NTproBNP
What can cause a raised BNP?
- LV hypertrophy
- Ischaemia
- R ventricular overload
- Hypoxaemia (due to PE)
What value BNP is pretty much diagnostic for HF?
> 100 ng/L
Give 5 CXR signs of HF:
(ABCDE): A - Alveolar oedema B - Kerley B lines C - Cardiomegaly D - Dilated prominent upper lobe vessels E - Pleural Effusion
Give the 5 types of HF:
- Acute/chronic
- Systolic HF - impaired ejection fraction
- Diastolic HF - Normal ejection fraction
- Right HF - systemic congestion
- Left HF - pulmonary congestion
What ventricular features are seen in left HF and right HF?
Left HF = LV hypertrophy
Right HF = LV thickening
Give 2 acute causes of HF:
- Pericarditis
- Acute MI
Give 4 symptoms and 4 signs of HF:
Symptoms:
- Fatigue, dyspnoea
- Paroxysmal nocturnal dyspnoea
- Peripheral oedema
- Palpitations
Signs:
- Hypotension
- ^ JVP
- Displaced apex beat
- Gallop rhythm (3rd HS)
Give the classification of HF:
(Based on patients performance in physical activity) NYHA classification: I - no limitation II - slight impairment III - Marked limitation IV - symptoms at rest
What approach to treatment in necessary in heart failure?
MDT:
- GP
- Cardiologist
- Cardiac surgeon
- HF nurse
- Cardiac rehab team
Outline the management of HF:
1) Diuretics + ACEi + BB
2) + Aldosterone antagonist (spironolactone)
3a) If QRS >120ms - pacemaker/defibrillator
3b) If QRS<120ms - digoxin + hydralazine & nitrates
What can be used as an alternative 1st line in those who are Afro-Caribbean with HF?
Digoxin + hydralazine & nitrates
What should be given instead of an ACEi in HF if ACEi is not tolerated?
An ARB
What effect does ACEi have on potassium?
Increases it.
What can ACEi cause?
Dry cough
When is aldosterone antagonists indicated in HF?
Indicated LV dysfunction
Class III or IV HF.
What are some sontrindication of the use of digoxin and beta-blockers in HF?
- Bradycardia
- 2nd/3rd degree heart block
What is hydralazine contraindicated in?
Lupus syndrome (= lupus-inducing drug)
What are IV nitrates good for in HF?
Isosorbide mononitrate. Good for controlling HF in acute decompensation (unless patient is symptomatically hypotensive)
Give 3 indications for warfarin:
- AF
- Prosthetic valves
- PE/recurrent DVT
Depression is a common disorder in many of those with chronic conditions (such as HF), which class of antidepressant should not be given to those with HF?
TCAs
Give 5 monitoring methods used in HF:
- Functional capacity (NYHA classification)
- Fluid status
- ECG
- BNP & NTproBNP
- MUGA Heart scan
Which peptide out of BNP and NTroBNP is more specific for detecting HF?
NTroBNP
Give 4 behavioural changes that can help improve prognostic factors:
- Reduce alcohol consumption
- Stop smoking
- Exercise
- Salt restriction
Give 3 non-cardiac and 3 cardiac causes of worsening HF:
Non-cardiac:
- Poor compliance
- PE
- Anaemia
Cardiac:
- AF
- Heart block
- Valve disease
What is high-output heart failure?
The only way to meet the O2 demands of the peripheral tissues is to increase the cardiac output. When the heart is unable to increase the CO (SV*HR) then high-output HF results
List 3 causes of high-output heart failure:
- Anaemia
- Pregnancy
- Multiple myeloma
