Management of Heart Failure

Question 1

What are the aims of treating cardiac failure?

Answer 1

• Improve symptoms / slow deterioration
• Reduce mortality
• Reduce cardiac events / admissions to hospital
• Avoid adverse treatment effects
• Improve end of life experience for both patients and carers

Question 2

What are the components of self-management for heart failure patients?

Answer 2

• Fluid allowance
  
  • Any type of fluid - max. 1.5L / day.
  • 1.5L because the body NEEDS 2L / day to be pushed through the kidneys for proper renal function; taken off 0.5L from this to account for the fluid in food.
• Daily weight
  
  • First thing in the morning after voiding urine.
  • Shows increase if there is excess fluid on board.
  • Patients are taught how to adjust diuretics based on their weight.
• Lifestyle changes

Question 3

What are the lifestyle modifications which should be undertaken by patients with heart failure?

Answer 3

• Food choices
• Weight management
• BP control
  
  • Often heart failure patients have low blood pressure
• Diabetes control
  
  • Must protect from HYPO
    
    • Warning sign of hypo = effects of sympathetic NS. These signs can be masked if the patient is on a beta-blocker so should allow them to run slightly high BM (8-12).
• Stop smoking
• Support
• Physical activity
• Immunisations
  
  • Flu jab
  • Pneumococcal vaccination
• Alcohol advice

Question 4

What are the possibilities for device insertion for patients with heart failure?

Answer 4

• ICD
  
  • Coil goes into right side of heart which will detect if the heart goes into VT or VF.
  • If it detects VT, it attempts to pace the patient out of it. This is anti-tachic pacing (ATP).
• Inplantable defibrilators
• CRT device
  
  • Cardiac resynchronisation therapy - resynchronises boh the ventricles.
  • Criteria for this is usually left bundle branch block.
• LVAD
  
  • Only used as a bridge to transplant
    *

Question 5

What are the driving restrictions associated with having an implantable defiblirator?

Answer 5

• Primary prevention - 1 month ban.
• Secondary prevention - 6 month ban.
• If shocks / therapy delivered within 6 months - automatic 2 year ban (unless meets certain criteria).