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Week 238 - Heart Failure Flashcards

1
Q

Week 238 - Heart Failure: What are the CXR signs of heart failure?

A
  • Caridomegaly
  • Upper zone vessel enlargement - A sign of pulmonary venous hypertension.
  • Pulmonary oedema - Bat-wing shape of increased lung-markings.
  • Kerley B lines.
  • Pleural effusions.
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2
Q

Week 238 - Heart Failure: What are Kerley B lines?

A
  • These are specific radiographic signs of pulmonary oedema.

* Small horizontal lines along the lateral borders of the lung fields.

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3
Q

Week 238 - Heart Failure: What is the management of renal deterioration?

A
  • Stop furosemide.
  • Decrease statins.
  • Commence isosorbide mononitrate and later hydralazine which are both vasodilators.
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4
Q

Week 238 - Heart Failure: When someone has features of both left and right sided heart failure they are said to have what?

A

Congestive cardiac failure.

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5
Q

Week 238 - Heart Failure: What is the presentation of Right sided heart failure?

A
  • Oedema and ascites.
  • Liver congestion - Impaired liver function.
  • GI tract congestion - Anorexia, GI distress, Weight loss.
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6
Q

Week 238 - Heart Failure: What is the presentation of Left heart failure?

A
  • Decreased cardiac output - Activity intolerance, Cyanosis, signs of hypoxia.
  • Pulmonary congestion - Othropnoea, Cough with frothy sputum, Paroxysmal nocturnal dyspnoea.
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7
Q

Week 238 - Heart Failure: What are the SIGNS of right-sided heart failure?

A
  • Anorexia
  • Increased JVP
  • Ascites
  • GI distress
  • Sacral oedema
  • Dependent oedema
  • Hepato/splenomegaly
  • Fatigue
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8
Q

Week 238 - Heart Failure: What are the SIGNS of left-sided heart failure?

A
  • Coughs, Crackles, Wheeze, PND, Orthopnoea, Tachypnoea
  • Cyanosis and hypocia
  • Frothy white sputum
  • Exertional dyspnoea
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9
Q

Week 238 - Heart Failure: What is the difference between systolic and diastolic heart failure?

A

Both are left-sided!
• Systolic - Insufficient contraction (E.g. post-MI)
• Diastolic - Insufficient relaxation

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10
Q

Week 238 - Heart Failure: What is the NYHA classification of heart failure?

A
  • Class 1 - Cardiac disease, but ordinary exercise does not cause undue fatigue, palpitation, dyspnoea or anginal pain.
  • Class 2 - Cardiac disease with a slight limitation on exercise but are comfortable at rest.
  • Class 3 - Cardiac disease with marked limitation on exercise but are comfortable at rest.
  • Class 4 - Cardiac disease with inability to carry out any physical activity without discomfort. Symptoms may be present at rest.
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11
Q

Week 238 - Heart Failure: What is the definition of acute heart failure?

A

A rapid change in the onset or change in symptom and signs of heart failure - Life-threatening.
- Often see in decompensation of a patient with chronic HF.

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12
Q

Week 238 - Heart Failure: How do people with acute heart failure usually present?

A

• Pulmonary oedema, cardiogenic shock or increasing dyspnoea.

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13
Q

Week 238 - Heart Failure: What is the general management of someone with acute heart failure?

A
  • Admission to monitored area.
  • Key drugs: Oxygen, diuretics and vasodilators.
  • Non-invasive ventilation may be needed.
  • Monitor: HR + rhythm, BP, Sats, urine output.
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14
Q

Week 238 - Heart Failure: In which situation should oxygen be administered in acute heart failure? What is the problem with using inappropriately?

A

• Use if Sp02

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15
Q

Week 238 - Heart Failure: What is the specific management of acute left ventricular failure?

A
  • Oxygen
  • Diamorphine 2.5mg IV
  • Metoclopramide 10 mg, IV
  • Furosemide 40-80mg, IV
  • IV nitrates
  • Consider non-invasive/mechanical ventilation.
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16
Q

Week 238 - Heart Failure: In the case of an acute on chronic heart failure situation, what diuretic may need to be added to furosemide?

A

Metolazone (thiazide-like)

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17
Q

Week 238 - Heart Failure: Which type of diuretic is ideal for the use with acute and chronic heart failure? Why?

A

Loop-diuretics - Furosemide.

• More potent diuresis and act quicker and last for a shorter time than thiazides.

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18
Q

Week 238 - Heart Failure: How do thiazides work?

A

• Act at the beginning of the distal convoluted tubule to inhibit Na+ reabsorption.

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19
Q

Week 238 - Heart Failure: How do loop diuretics work?

A

As it says on the tin, they act on the loop of Henle by inhibiting Na+ reabsorption.

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20
Q

Week 238 - Heart Failure: What are the side-effects of thiazide (and related) diuretics?

A
  • Electrolyte disturbance - reduced Na+ and K+
  • Increased risk of gout due to increased urate.
  • Hyperglycaemia.
  • Deranged lipids.
21
Q

Week 238 - Heart Failure: Give some examples of thiazide diuretics.

A
  • Bendroflumethiazide
  • Chlortalidone
  • Hydrochlorothiazide
  • Metolazone
  • Indapamide
22
Q

Week 238 - Heart Failure: What role do opiates play in the treatment of acute heart failure?

A
  • Relieve anxiety and distress due to dyspnoea.

* Venodilators

23
Q

Week 238 - Heart Failure: How do vasodilators help in heart-failure?

A

Reduce preload, afterload and increases stroke volume.

24
Q

Week 238 - Heart Failure: Nitroglycerine is a vasodilator used in treatment of heart-failure, however it does not relieve dyspnoea. Which vasodilator does?

A

Nesiritide.

25
Q

Week 238 - Heart Failure: Once acute heart failure has been stabilised what is the medication used?

A

ACE-inhibitor

Beta blocker

26
Q

Week 238 - Heart Failure: In NYHA class II-IV which three drug classes are strongly recommended for therapeutic use?

A
  • ACE-I
  • Beta blocker
  • Mineralocorticoid receptor antagonist
27
Q

Week 238 - Heart Failure: In which patients are ACE-I indicated for?

A

All those with a left-ventricular ejection fraction of

28
Q

Week 238 - Heart Failure: How do ACE-I improve pre-load and after load?

A
  • ACE-I reduce the breakdown of Bradykinin. (along with effect of ATII)
  • Bradykinin is an inflammatory mediator which leads to vasodilation.
  • This vasodilation is why pre-load and after-load are reduced.
29
Q

Week 238 - Heart Failure: Which ACE-I is still frequently used in paediatric cardiology?

A

Captopril

30
Q

Week 238 - Heart Failure: What are the contraindications for use of an ACE-I?

A
  • Severe aortic stenosis, mitral stenosis, Left-ventricular outflow obstruction
  • Bilateral renal artery stenosis
  • Pregnancy
  • History of idiopathic/hereditary angioedema
  • Creatine >220umol/l
31
Q

Week 238 - Heart Failure: Give examples of some Angiotensin II receptor antagonists.

A
  • Candesartan
  • Valsartan
  • Erpotsartan
  • Losartan
32
Q

Week 238 - Heart Failure: What should be used instead of ACEI/ARBs if they are not tolerated?

A

Isosobide dinitrate and hydralazine.
(Along with Beta-blocker,digoxin,aldosterone antagonist)
(If still symptomatic)

33
Q

Week 238 - Heart Failure: What is the role of aldosterone antagonism in treatment of heart failure?

A

• Added to conventional therapies in order to suppress aldosterone levels - cardioprotective.

34
Q

Week 238 - Heart Failure: In which patients are aldosterone antagonists indicated?

A

• Severe symptomatic heart failure (grade III/IV) with LVEF

35
Q

Week 238 - Heart Failure: What do alpha-receptor agonists do? (Vascular)

A

• Constrict vessels

  • Increases Total peripheral resistance
  • Increases central venous pressure > Decreases cardiac output
36
Q

Week 238 - Heart Failure: What are the main contraindications of beta-blockers?

A
  • Asthma / COPD
  • Cardiac conduction defects.
  • Severe heart failure
  • Severe peripheral vascular disease
  • Raynaud’s disease
37
Q

Week 238 - Heart Failure: Which beta-blockers have specifically been show to be helpful in heart failure?

A
  • Bisoprolol
  • Carvedilol
  • Metoprolol
  • Nebivilol
38
Q

Week 238 - Heart Failure: Which beta-blocker is used in pregnancy and is used as an IV infusion for the rapid control of BP?

A

• Labetolol

39
Q

Week 238 - Heart Failure: What is Ivabradine?

A

It inhibits the If(funny) channel in the sinus node, thereby slowing the heart rate in sinus rhythm.
- Has been shown to reduce hospitalisation in HF patients.

40
Q

Week 238 - Heart Failure: Why do you get oedema in heart failure?

A

Increases in venous pressure and GFR causes salt and water retention.

41
Q

Week 238 - Heart Failure: What are the common causes of heart failure?

A
  • IHD
  • Hypertension
  • Valvular heart disease
  • Cardiomyopathy
  • Toxic - alcohol
  • Diabetes
42
Q

Week 238 - Heart Failure: What are the main causes of right heart failure?

A
  • Chronic lung disease
  • Pulmonary hypertension
  • Left to right intra cardiac shunts
  • Chronic valvular heart disease
43
Q

Week 238 - Heart Failure: What is cardiac cachexia?

A

Weight loss and anorexia commonly seen in heart failure.

- Due to metabolic changes, gut congestion, reduced intake and inflammatory causes.

44
Q

Week 238 - Heart Failure: Which of the types of left-sided heart failure has a normal ejection fraction?

A

Diastolic

45
Q

Week 238 - Heart Failure: What are the differential diagnoses for high output heart failure?

A
  • Anaemia
  • Septicaemia
  • Liver-failure
  • Beri-beri
  • Thyrotoxicosis
  • Paget’s disease
  • AV shunt
46
Q

Week 238 - Heart Failure: The increase of which substances in the blood may indicate myocardial wall stress?

A
  • B-type natriuretic peptide (BNP)

* N-terminal pro-BNP

47
Q

Week 238 - Heart Failure: What may you see on an echocardiogram that would suggest heart failure?

A
  • Dilated LV/RV
  • Reduced LV/RD contractility
  • Valve lesions
48
Q

Week 238 - Heart Failure: What are the surgical options for treatment of heart failure?

A

Depends on the underlying cause.

  • Revascularisation - CABG and PCI
  • Treatment of valvular heart disease
49
Q

Week 238 - Heart Failure: What changes occur during auscultation of the heart in heart failure?

A

Third heart sound - gallop rhythm

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