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Cardiology > 1: Heart Failure > Flashcards

1: Heart Failure Flashcards

1
Q

Define Heart Failure

A

When cardiac output is insufficient to meet the bodies requirements

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2
Q

What are the two types of heart failure

A

Systolic and diastolic

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3
Q

What is systolic heart failure

A

Impaired ability of the heart to contract - resulting in impaired cardiac output

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4
Q

How can systolic HF be identified

A

An Ejection Fraction <40%

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5
Q

What is diastolic heart failure

A

Impaired ability of the heart to relax resulting in increasing filling pressure and reduced filling

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6
Q

What is diastolic heart failure also referred to as

A

Heart Failure with Preserved Ejection Fraction

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7
Q

What is the ejection fraction in diastolic heart failure

A

>50%

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8
Q

What are the 3 types of heart failure relating to site

A

Left-sided HF

Right-sided HF

Congestive (biventricular HF)

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9
Q

What is high-output heart failure

A

When there is no intrinsic problem with the heart, but there is increased demand. Heart failure occurs when the increased demand cannot be met

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10
Q

How common is high output heart failure

A

Rare

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11
Q

What is low output heart failure

A

Where cardiac output is low and does not increase with demand

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12
Q

What is acute heart failure

A

new onset or decompensation of chronic heart failure. Which present with symptoms of peripheral oedema or pulmonary oedema, with or without signs of peripheral hypoperfusion.

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13
Q

What is chronic heart failure

A

clinically compensated heart failure

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14
Q

How does the incidence of HF change with age

A

Incidence of HF increases

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15
Q

What are 2 common causes of systolic HF

A

IHD

Cardiomyopathy

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16
Q

What are 5 causes of diastolic heart failure

A

Left ventricular hypertrophy

Restrictive cardiomyopathy

Cardiac tamponade

Constrictive pericarditis

Obesity

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17
Q

What are 3 causes of left ventricular failure

A

Aortic stenosis

Mitral regurgitation

HTN

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18
Q

What are 3 causes of right ventricular failure

A

Cor Pulmonale

Left-sided HF

Pulmonary stenosis

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19
Q

What is the commonest cause of right ventricular failure

A

Cor pulmonale secondary to COPD

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20
Q

What are the 3 aetiological categories of low-output HF

A
  1. Excess pre-load
  2. Pump Failure
  3. Excess afterload
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21
Q

What are the 2 causes of low-out put HF due to excess pre-load

A

Fluid Overload

Mitral regurgitation

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22
Q

What are the 2 causes of pump failure leading to low-output HF

A
  • Reduced SA node activity (eg. B blockers)
  • Negative inotropic drugs
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23
Q

What are the 2 causes of low-output HF due to chronic afterload

A
  • aortic stenosis
  • HTN
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24
Q

What are 6 causes of high output HF

A
  • pregnancy
  • hyperthyroidism
  • beri beri
  • anaemia
  • paget’s disease
  • AV malformation
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25
What are 10 symptoms of left-sided HF
* Dyspneoa * Orthopneoa * Paroxysmal Nocturnal Dyspneoa * Nocturnal cough - productive of pink frothy sputum * Wheeze * Lethargy * Cold extremities * Weight loss
26
What are 6 symptoms of right-sided HF
* Peripheral oedema * Ascites * Facial engorment * Epistaxis * Anorexia * Nausea
27
How will congestive heart failure present clincially
Symptoms of both left and right HF
28
What criteria is used to diagnose HF
Framingham criteria
29
What diagnostic criteria can be used to diagnose heart failure
Framingham
30
What does the Franingham criteria state is requried to diagnose HF
To diagnose congestive HF indiviudal must have at least 1 major and 2 minor symptoms. Or, 2 major symptoms
31
What are the 8 major franingham criteria
* \>4.5Kg weight loss in 5 days following treatment * S3 Gallop rhythm * Pulmonary rales * PND * Neck vein distention * Hepatojugular reflex * Cardiomegaly * Acute pulmonary oedema
32
What are the 6 minor franingham criteria
* Ankle oedema * Dyspneoa on exertion * Hepatomegaly * Nocturnal cough * Pleural effusion * Tachycardia \>120
33
What scale is used to assess the severity of heart failure
New York Heart Association
34
What is NYHA I criteria
Ordinary physical activity not limited by symptoms
35
What is NHYA II criteria
Slight limitation of physical activity. Symptoms occur on physical activity.
36
What is NYHA criteria III
Marked limitation of physical activity. Symptoms occur at less than ordinary levels of physical activity
37
What is NYHA criteria IV
Symptoms at rest
38
What is first-line investigation for HF
N-terminal pro BNP- (NT pro BNP)
39
If an individual has a pro NT BNP of \>2000 what should be done
Refer for urgent transthoracic ECHO within 2W
40
If an individal has a pro-NT BNP of 400-2000 what should be done
Refer for transthoracic ECHO in 6W
41
If an individual has a NT pro BNP of \<400 what should be done
Consider an alternative diagnosis
42
What is second line investigation for HF
Transthoracic ECHO
43
how soon should a transthoracic ECHO be performed if a. BNP \>2000 b. BNP: 400-2000
a. 2W b. 6W
44
What may be seen on an ECG on heart failure
Non-specific findings (perhaps indicating underlyign cause) - Ischaemic changes (evidence of past MIs) - Sokolov-Lyon Criteria = indicate LVH (and left axis deviation) - Arrythmias
45
What are the features of HF on CXR
**A**lveolar oedema (Bat wing sign) Kerley **B** lines **C**ardiomegaly **D**ilated upper lobe veins pleural **E**ffusions
46
What is first-line for the managemement of CHRONIC heart failure
ACEi and B blocker
47
What are the 3 B blocks that can be used in HF
**Carvediol** Bisoprolol Nabivolol
48
What should be checked before starting a ACEi
U+E Renal function
49
How should B blocker and ACEi be started in HF
Should be started individually - it doesn't matter which drug is started first
50
What is second line to manage HF
Spirinolactone
51
When should spirinolactone be addedd to management of HF
If individuals are still symptomatic despite B blocker and ACEi
52
What else may be given to manage HF
53
What are the indications for ivabrandine in the management of HF
HR \>75 Class III or IV HF Given with other medications (ACEi, B blocker, Spirinolactone)
54
When may digoxin be given in HF
Severe HF with reduced ejection fraction despite optimal therapy
55
What two vaccines should individuals with heart failure have
pneumococcal vaccine annual influenza vaccine
56
What are 3 pieces of lifestyle advice for someone with HF
Smoking cessation Reduce Salt Consumption Reduce Alcohol Intake
57
What 4 drugs improve survival in HF
**B**blocker **A**CEi **S**pirolonactone **H**ydralazine w/nitrates
58
What are 2 scoring systems that can be used to predict survival in HF
* CHARM * Corona
59
What is prognosis of the following NYHA grades of HF a. I b. II c. III d. IV
a. 95% b. 85% c. 85% d. 35%
60
What are 3 complications of heat failure
Pulmonary oedema Renal failure Portal HTN **Atrial fibrillation**

Cardiology (13 decks)

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