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AKT > Cardiovascular Disease > Flashcards

Cardiovascular Disease Flashcards

1
Q

What are the typical symptoms of heart failure?

A

-Breathlessness
-Fluid retention
-Fatigue
-Lightheadedness/Syncope

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2
Q

What types of breathlessness can occur when a patient has heart failure?

A

-Exertional
-Non-exertional
-Orthopnoea
-Paroxysmal nocturnal dyspnoea
-Nocturnal cough

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3
Q

Where might a patient with heart failure experience/report fluid retention?

A

-Ankles
-Abdomen

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4
Q

What risk factors in a patient’s medical history might there be for heart failure?

A

-Coronary artery disease/previous MI
-HTN
-AF
-DM

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5
Q

A patient presents with a history of progressively worsening shortness of breath especially when lying flat, and swelling of legs.

What observations would increase suspicion of heart failure?

A

-Tachycardia
-Tachypnoea
-Hypertension

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6
Q

A patient presents with a history of progressively worsening shortness of breath especially when lying flat, and swelling of legs.

What examination findings in the chest might indicate heart failure?

A

-Laterally displaced apex beat
-Heart murmur
-Basal crepitations
-Pleural effusion

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7
Q

A patient presents with a history of progressively worsening shortness of breath especially when lying flat, and swelling of legs.

What examination findings outside of the chest might indicate heart failure?

A

-Raised JVP
-Enlarged liver
-Dependant oedema or ascites
-Obesity

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8
Q

A patient presents with a history of progressively worsening shortness of breath especially when lying flat, and swelling of legs.

How should the likely condition be investigated?

A

Heart failure

-N-terminal pro-B-type natriuretic peptide
-12 lead ECG
-Other tests as appropriate for any other underlying pathology

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9
Q

How should NT-pro BNP level be interpretted?

A

Over 2000 - refer for specialist assessment and echo within 2 weeks

400-2000 - refer for specialist assessment and echo within 6 weeks

Less than 400 - diagnosis of heart failure is less likely

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10
Q

A patient presents with a history of progressively worsening shortness of breath especially when lying flat, and swelling of legs.

Other than NT-pro BNP and ECG, what tests may be appropriate to determine cause?

A

-Chest x-ray
-Bloods inc FBC, U&Es, TFTs, LFTs etc
-Urine dip
-Lung function tests

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11
Q

In which groups of people might NT-pro BNP be reduced?

A

-Those with BMI >35
-Those on diuretics/ACE-Is/ARBs/beta blockers
-Those of Afro-Caribbean origin

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12
Q

Other than heart failure, what can increase levels of NT-pro BNP?

A

-Age over 70
-LVH/MI/tachycardia
-RV overload
-Hypoxia
-Pulmonary HTN
-PE
-CKD
-Sepsis
-COPD
-DM
-Liver cirrhosis

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13
Q

A patient presents with a history of progressively worsening shortness of breath especially when lying flat, and swelling of legs.

What conditions could explain the breathlessness other than heart failure?

A

-COPD
-Asthma
-PE
-Lung Cancer
-Anxiety

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14
Q

A patient presents with a history of progressively worsening shortness of breath especially when lying flat, and swelling of legs.

What conditions could explain the peripheral oedema other than heart failure?

A

-Prolonged inactivity or venous insufficiency
-Nephrotic syndrome
-Medication
-Hypoalbuminaemia
-Pelvic tumour

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15
Q

What is heart failure caused by?

A

Structural and/or functional abnormality that produces raised intracardiac pressure &/or inadequate cardiac output at rest &/or at exercise

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16
Q

What defines they type of heart failure a patient has?

A

Ejection fraction

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17
Q

What level of LVEF (left ventricular ejection fraction) counts as reduced ejection fraction?

A

<40%

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18
Q

What level of LVEF (left ventricular ejection fraction) counts as mildly reduced ejection fraction?

A

41-49%

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19
Q

What level of LVEF (left ventricular ejection fraction) counts as preserved ejection fraction?

A

> 50%

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20
Q

What proportion of patients with heart failure have preserved ejection fraction?

A

Nearly half

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21
Q

What system is used to classify the severity of heart failure?

A

New York Heart Association classification

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22
Q

What are the categories in NYHA classification for heart failure?

A

Class I to Class IV

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23
Q

What is Class I NYHA classification?

A

No limitation of physical activity

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24
Q

What is Class II NYHA classification?

A

Slight limitation of physical activity but comfortable at rest

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25
Q

What is Class III NYHA classification?

A

Marked limitation of physical activity but comfortable at rest

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26
Q

What is Class IV NYHA classification?

A

Unable to carry out any physical activity without discomfort, symptoms can be present at rest

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27
Q

What myocardial diseases can lead to heart failure?

A

-Coronary artery disease
-HTN
-Cardiomyopathies

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28
Q

Can valvular heart disease cause heart failure?

A

Yes

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29
Q

What pericardial disease can cause heart failure?

A

-Constrictive pericarditis
-Pericardial effusion

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30
Q

Can congenital heart disease cause heart failure?

A

Yes

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31
Q

Can arrythmias cause heart failure?

A

Yes - AF and other tachyarrythmias can

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32
Q

What high output states can cause heart failure?

A

-Anaemia
-Thyrotoxicosis
-Phaemochromocytoma
-Sepsis
-Liver failure
-AV shunt
-Paget’s disease
-Thiamine deficiency

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33
Q

What causes of volume overload can cause heart failure?

A

-End-stage CKD
-Nephrotic syndrome

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34
Q

Can obesity cause heart failure?

A

Yes

35
Q

What drugs can cause heart failure?

A

-Alcohol
-Cocaine
-NSAIDs
-Beta blockers
-Calcium channel blockers

36
Q

What is the average age of first diagnosis of heart failure?

A

76 years

37
Q

What sign at time of diagnosis confers better prognosis of newly diagnosed heart failure?

A

Not requiring hospital admission

38
Q

What are some of the poor prognostic factors for heart failure?

A

-Increasing age
-Reduced EF
-Presence of co-morbidities
-Worsening severity of symptoms/signs
-Obesity/cachexia
-Smoking
-Hx of IHD
-Presence of complex arrhythmias

39
Q

Can heart failure cause arrhythmias?

A

Yes - AF and other ventricular arrhythmias

40
Q

How common is depression in heart failure?

A

Common - around 20% of people with heart failure have major depressive order

41
Q

Can heart failure cause anaemia?

A

Yes

42
Q

What proportion of deaths in people with heart failure are due to sudden cardiac death?

A

30-40%

43
Q

What can be done during a medication review for a patient with newly diagnosed heart failure?

A

Stop/reduce any drugs that may contribute to symptoms/worsen heart failure

NSAIDs, beta-blockers (in some scenarios), Ca Channel blockers

44
Q

What should first line medical management of fluid overload symptoms be in a patient with newly diagnosed heart failure?

A

Prescribe a loop diuretic

45
Q

What loop diuretics can be prescribed first line for heart failure?

A

Bumetanide
Furosemide
Torasemide

46
Q

How should loop diuretic dose be titrated in heart failure?

A

According to symptoms

47
Q

A patient with heart failure is on the maximal dose of oral loop diuretic but has ongoing symptoms. What needs to be done in this situation?

A

Referral for specialist advice

48
Q

A patient with newly diagnosed heart failure with LVEF 38% has been prescribed furosemide for symptom control.

What else can you prescribe for symptom control and to improve prognosis?

A

ACE-I and beta-blocker

49
Q

In what situation is an ACE inhibitor for reduced EF heart failure contraindicated?

A

-Haemodynamically significant valvular disease unless assessed by specialist
-Pt unable to tolerate ACE-I

50
Q

In what situation is a beta blocker for reduced EF heart failure contra-indicated?

A

With concurrent Diabetes Mellitus

51
Q

If a patient with heart failure is unable to tolerate an ACE inhibitor, what can be commenced instead?

A

Angiotensin-II receptor antagonist

52
Q

In addition to loop diuretic, ACE-I/ARB, and beta blocker, what can be considered to manage heart failure?

A

SGLT2 inhibitor e.g. dapagliflozin
Aldosterone antagonist e.g. spironalactone

53
Q

When should an antiplatelet be considered for a patient with HFrEF?

A

Patients with atherosclerotic arterial disease

54
Q

What non-cardiac symptoms/conditions need to be screened for in patients with heart failure?

A

Depression and anxiety

55
Q

What can be done if a patient is obese or underweight with concurrent heart failure?

A

Refer for dietetic advice for underweight pts
Advice on achieving healthy weight if BMI over 30

56
Q

When should advance care planning be considered if a patient has been diagnosed with hearth failure?

A

Should be considered in early stages of the disease

The earlier the better, however this is not always practical

57
Q

How should new medications be started when managing a patient with heart failure?

A

One at a time, stabilise on one before starting to titrate another

58
Q

Are aldosterone antagonists or SGLT2 inhibitors recommended by NICE for management of HFrEF?

A

No however other guidelines suggest they can be considered with specialist input

59
Q

In mildly reduced ejection fraction heart failure, what medications are recommended by NICE to manage mildly reduced EF heart failure?

A
  1. Loop diuretics
  2. ACE-I
  3. Beta blocker
  4. Aldosterone antagonist
  5. Sacubitril valsartan
60
Q

What is the recommendation regarding Dapagliflozin in management of chronic symptomatic heart failure with preserved or mildly reduced heart failure?

A

Can be commenced with specialist input

61
Q

What medications are recommended for managing HFpEF?

A

Loop diuretics

Dapagloflozin with specialist input if optimal diuretics does not improve symptoms

62
Q

What is regarded as being end-stage heart failure?

A

If the patient is at high risk of dying within 6-12 months

63
Q

What indicators are there for end-stage heart failure?

A

-Frequent hospital admissions
-Poor response to treatment
-Increasing NYHA score
-Cachexia
-Low serum albumin
-Declining eGFR and BP
-Poor QoL &/or functional status

64
Q

A patient with end stage heart failure is becoming more unwell and it is becoming more difficult to control their symptoms.

An ICD had been implanted a few years ago. What needs to be considered at this time?

A

Deactivation of ICD

65
Q

What palliative medications could be considered to manage breathlessness in end stage heart failure?

A

Opiates
Benzodiazepine
Home oxygen

66
Q

What palliative medications could be considered to manage chest pain in end stage heart failure?

A

Morphine
Nitrates

67
Q

A patient with end stage heart failure is newly registered at the practice.

What do you need to ensure they have?

A

Advance care plan
RESPECT form
Medicine optimisation
Anticipatory medicines
Psychological support

68
Q

What symptoms should a GP advise a patient with heart failure to look out for?

A

Increasing SoB, fatigue, ankle/abdominal swelling, or rapid weight gain

69
Q

What is a useful measure of oedema when reviewing a patient with heart failure?

A

Weight

70
Q

How frequently can you advise a patient with heart failure to weigh themselves to help monitor their fluid renetion?

A

Daily, weekly, or fortnightly depending on level of risk of deterioration

71
Q

What dietary advice can be given to a patient with heart failure?

A

-Reduce salt intake (<5g per day)
-Mediterranean diet
-Fluid restrict within safe limits

72
Q

What advice should be given regarding heart failure and driving?

A

Pts responsibility to inform DVLA of any condition whcih may affect ability to drive and should check with insurer if they are covered

Group 2 drivers are disqualified from driving if they are symptomatic but they can be relicensed

73
Q

How frequently should a patient with stable heart failure be monitored?

A

At least 6 monthly

74
Q

Which ARBs are licensed in UK for treatment of heart failure?

A

Candesartan
Losartan
Valsartan

75
Q

What should be checked before commencing an ARB?

A

Renal function
Serum electrolytes inc. potassium
BP

76
Q

What measurements would contraindicate commencing an ARB for heart failure?

A

Potassium greater than 5 alongside CKD

77
Q

How soon after commencing and ARB should U&Es and BP be rechecked?

A

1-2 weeks, earlier if higher risk e.g. pre-existing CKD/more comorbidities/polypharmacy

78
Q

Once a patient is stabilised on an ARB, how frequently should U&Es be monitored?

A

Once a month for 3 months, then 6 monthly plus any time they are unwell

79
Q

What are the sick-day rules for ARBs?

A

If pt has D&V - Maintain fluid intake, stop ARB for 1-2 days until they recover

80
Q

What measurement in U&Es can increase due to an ARB?

A

Creatinine

81
Q

What level is a non-concerning creatinine rise following commencement of an ARB?

A

Less than 30%

82
Q

Up to what level of potassium is acceptable with an ARB?

A

5.5 mmol/L

83
Q
A

AKT (22 decks)

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