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Heart failure Flashcards

1
Q

What is meant by heart failure?

A

This is a state in which the heart is unable to pump blood at a rate commensurate with the requirements of tissue, or can only do so at high pressure

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2
Q

What is meant by HF-pEF?

A

Heart Failure with preserves Ejection Fraction

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3
Q

What is meant by HF-rEF?

A

Heart Failure with reduced Ejection Fraction

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4
Q

What is ejection fraction?

A

This is the percentage of blood that is pumped out of the heart during each beat

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5
Q

What is considered to be a normal ejection fraction?

A

≥50%

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6
Q

What is meant by a reduced ejection fraction in heart failure?

A

≤40%

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7
Q

What are some conditions that can cause systolic dysfunction in heart failure?

A

Arrhythmia
Myocarditis
Dilated cardiomyopathy
Ischaemic heart disease

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8
Q

What are some conditions that can cause diastolic dysfunction in heart failure?

A

Hypertrophic Obstructive Cardiomyopathy
Restrictive cardiomyopathy
Cardiac tamponade
Constrictive pericarditis

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9
Q

What are some core symptoms in heart failure?

A

Dyspnoea
Cough
Paroxysmal Nocturnal Dyspnoea
Orthopnoea
Fatigue
Peripheral oedema

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10
Q

What sided heart failure will usually cause pulmonary oedema?

A

Left - Lungs

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11
Q

What sided heart failure will usually cause peripheral oedema?

A

Right - Rest of body

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12
Q

How is the effect of heart failure on physical activity classified?

A

New York Heart Association Classification:
I - No limitation to physical activity
II - Slight limitation to physical activity
III - Marked limitation of physical activity
IV - Unable to carry out physical activity

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13
Q

What are some clinical signs of heart failure?

A

Elevated JVP
Tachycardia
Cardiomegaly
S3 and S4 heart sounds
Bi-basal crackles
Ascites
Tender hepatomegaly
Ankle oedema

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14
Q

What are some symptoms more suggestive of left sided heart failure?

A

pulmonary oedema:
dyspnoea
orthopnoea
paroxysmal nocturnal dyspnoea
bibasal fine crackles

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15
Q

What are some symptoms more suggestive of right sided heart failure?

A

peripheral oedema
ankle/sacral oedema
raised jugular venous pressure
hepatomegaly
weight gain due to fluid retention
anorexia (‘cardiac cachexia’)

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16
Q

What are some ways in which the body can initially compensate for heart failure?

A

Increased adrenergic activity, therefore increasing heart rate, blood pressure and cardiac contractility

Increased angiotensin II production, causing vasoconstriction and thus increasing afterload

Increased aldosterone production therefore causing water retention and thus increasing blood pressure

Secretion of BNP, which works to decrease blood pressure if strain is too high on the heart

17
Q

What investigations are required in heart failure?

A

History and examination
NT-Pro-BNP testing
ECG
Echocardiogram
Bloods
CXR

18
Q

What is the NT-pro-BNP test useful for?

A

It has a high sensitivity but a low specificity, so can be used to rule out those who do not have heart failure

19
Q

What are the 5 stages of management of a patient with heart failure? (RAMPS)

A

R - Refer to cardiology
A - Advise about condition
M - Medical treatment
P - Procedural or surgical intervention
S - Specialist MDT input

20
Q

What is the first line pharmacological treatment in HF-pEF?

A

Loop diuretics (e.g. furosemide)

21
Q

What are the 4 main drugs used in treatment of HF-rEF?

A

A - ACEi or ARB
B - ß-Blockers
A - Aldosterone antagonist
L - Loop diuretic

22
Q

What are some 2nd line drugs that can be trialled in HF-rEF?

A

HCN channel blocker - Ivabradine
Angiotensin Receptor Neprilysin Inhibitor (ARNI) - Salcubatril valsartan
Vasodilator - Hyralazine
SGLT2 inhibitors - Dapagliflozin
Digoxin

23
Q

How is acute heart failure first treated?

A

L - Loop diuretic IV
M - Morphine IV
N - Nitrates
O - Oxygen
P - Position sitting up

24
Q

What is the effect of an ARNI (e.g. salcubatril valsartan)?

A

This decreases blood pressure, sympathetic tones and aldosterone levels, while enhancing the effects of natriuretic peptides

25
Q

What are some lifestyle management techniques that should be used in heart failure?

A

Exercise-based rehabilitation
Reduce fluid intake
Reduce salt intake
Keep vaccinations up to date
Manage mental health

26
Q

How will heart failure present on chest x-ray?

A
27
Q

What are some possible complications of heart failure?

A

Arrythmias - most commonly AF and ventricular arrhythmias
Depression
Cachexia
Chronic kidney disease
Sudden cardiac death

New cardio (28 decks)

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