CARDIOLOGY - HEART FAILURE Flashcards
What is the percentage of LVEF for heart failure with preserved ejection fraction ?
more than or equal to 50%
Specific symptoms of Heart failure
Raised JVP
Third heart sound
hepatojugular reflexes
Displaced apex beat
What is the complication of heart failure ?
Arrhythmia
Secondary regurgitation
Hepatorenal syndrome
Acute kidney injury
Hypoxia
Lactic acidosis
What investigation you want to order for diagnosing HF ?
N-Terminal Pro brain Natriuretric Peptide (NT-ProBNP) / BNP
BNP is a hormone that is released by the heart when it is stress
The higher the BNP , the more stressed the heart
What is the cutoff point for BNP in Acute and Non-acute setting ?
Acute means the patient experience sudden and rapid onset of symptoms
Non acute means the patient not experience sudden and rapid onset of symptoms
Non acute setting cutoff 125 pg/ml
Acute setting cutoff 300 pg/ml
If the BNP test is negative , what is the significant for you ?
90% chance that the person do not have HF
What other investigation you want to do to diagnose HF ?
Echocardiography
If you want to look for the cause of HF , what investigation can you do ?
Imaging
Blood test
Through imaging (look for the cause ) , what imaging test you want to do ?
1) ECG
-regional wall motion abnormality = ischemic cause
-stress ECG : look for exercise induced diastolic failure
2)Cardiac MRI
-gold standard to measure the heart chambers volume and ejection fracture
-scarring = ischemia changes
3)Coronary angiography
-look for coronary artery disease
Through Blood (look for cause) , what investigation you want to order ?
Full Blood count
Fasting Lipid Panel
Ferritin
Ferritin is a protein that stores iron in the body.
It is also an acute-phase reactant, meaning that its levels rise in response to inflammation.
What investigation you want to order to look for the complication of heart failure ?
BUSE / Creatinine
-cardiorenal syndrome effect
Liver Function Test
-cardioliver syndrome effect
Chest X-ray
-ABCDE
Thoracic ultrasound
- look for pleural effusions
ECG
-Atrial fibrillation
BUSE is clinical presentation of cardiorenal syndrome
Blood Urea Serum Electrolyte
What is the step to treat Acute stage HF ?
1) Resuscitate
2)Diuresis
-IV frusemide (congestion relieve)
3)Diagnostic tests
-NT-ProBNP
4)Find out possible causes
5)Admission and stabilize
What is the quick pharmacotherapy during AHF ?
IV frusemide - relieve congestion
IV Dobutamine -inotropic support
What drugs cannot be given to HF patient ?
NAATV
NSAIDS - inhibit prostaglandins cause VC
Alpha blocker - cause fluid retention
ARB not mixed with ARNI - extreme vasodilation
Thiazolidinediones - increase fludi retention
Verapamil - Calcium Channel Blocker ,decrease contractility
What to do with atrial fibrillation ?
-CHADVASC & HASBLED score to determine the warfarin usage
-NOAC (Non Vitamin K Oral Anticoagulant) : non valvular AF
-warfarin for 3 weeks -> Transesophageal Echocardiography -> cardioversion
