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Yr 5 Cardiology > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

What is the mechanism behind systolic HF?

A

Ventricles enlarged
Unable to contract fully
↓CO + ejection fraction < 40%

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2
Q

What are the causes of systolic HF?

A

IHD
MI
Cardiomyopathy

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3
Q

What is the mechanism behind diastolic HF?

A

Stiff ventricles cannot relax fully
↑filling pressure
Ejection fraction > 50%

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4
Q

What are the causes of diastolic HF?

A

Constrictive pericarditis
HTN
Cardiomyopathy

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5
Q

How are HF causes divided?

A

LOW OUTPUT = reduced heart function

HIGH OUTPUT = Heart working at normal/inc rate but body has greater demand

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6
Q

What are the causes of low output HF?

A

Inc pre-load: MR, fluid overload
Pump failure: IHD, MI, (restrictive) Cardiomyopathy, AF, tamponade
Chronic excessive overload: AS, HTN

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7
Q

What are the causes of high output HF?

A

Hyperthyroid
Anaemia
Paget’s
AV malformation

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8
Q

What are the Sx of LVF?

A 
Dyspnoea → Orthopnoea → PND
Nocturnal cough- pink frothy sputum
↓weight
Muscle wasting
Fatigue/lethargy
Cyanosis
Basal creps
Displaced Apex beat
Pulsus alternans
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9
Q

What are the Sx of RVF?

A 
Peripheral oedema (calfs &amp; ascites)
N&amp;V (pressure on stomach)
Dyspnoea
↑JVP 
↑Weight
Poor exercise tolerance
Confusion
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10
Q

How is HF investigated?

A 
ECG
BNP
CXR
Bloods: FBC, U&amp;E, LFT, TFT, Lipids, Glucose
Urine dip: Check for proteins
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11
Q

What is seen on an ECG in HF?

A

Exaggerated R waves V1-6 = LVH
Inverted R waves V1-6 = RVH
Axis deviation

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12
Q

What do the different BNP levels correlate to?

A

> 400/Prev MI: 2w referral for doppler ECHO
100-400: 6w referral for doppler ECHO
<100: likely not HF

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13
Q

How is acute HF treated?

A 
LMNOP's:
L: Loop diuretics 40-80mg Slow IV
M: Morphine &amp; Metoclopramide
N: Nitrates- 2sprays GTN
O: O2 15L/min
P: Position- sit up
S: SHIT!- CPAP
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14
Q

What needs to be monitored in acute HF in someone on loop diuretics?

A 
U&amp;E
eGFR
ACR
Weight
Urine output
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15
Q

How is stable HF initially managed?

A

1) ACEi: Ramipril → ARB if not tolerated
2) BB: Bisoprolol
FOLLOW-UP in 2w w/HF team

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16
Q

Why are beta-blockers given in HF?

A

Prevent cardiac remodelling

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17
Q

What surgery can be offered in HF?

A

AV replacement: Due to severe AS

Implantable cardioverter defibrillator: Prev VT/VF, familial CV condition, surgical repair of congenital HD

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18
Q

What is the NYHA classification of HF?

A

1: No limitation, normal activity
2: Slight limitation, ordinary activity
3: Marked limitation, less than ordinary activity
4: Unable to carry out activity w/o discomfort, Sx of HF at rest

19
Q

What additional medications can be given to those of NYHA stage 3-4?

A

Aldosterone antagonist (Spironolactone)
Hydralazine +/- Nitrate
Valsartan
3rd line: Digoxin

20
Q

How is cardiomyopathy categorised?

A

Dilated- MOST COMMON
Hypertrophic- MAIN CAUSE OF DEATH IN YOUNG PTS
Restrictive

21
Q

What are the causes of dilated cardiomyopathy?

A 
Idiopathic
DMD
Infection (Coxsackie, Chaga)
OH-
Drugs (Chemo-Doxorubicin, Cocaine)
Peri-partum
22
Q

What happens in dilated cardiomyopathy?

A 
Dilatation of all 4 chambers
Mostly LV
= thin walls
= weak contractile strength
↓SV (less blood pumped) → systolic HF
23
Q

What complications can arise from dilated cardiomyopathy?

A

Arrhythmia: Stretching → pacemaker cell dysfunction
Murmur: Dilated ventricle → Tricuspid & mitral valve fail to close properly = Regurg

24
Q

What are the causes of hypertrophic cardiomyopathy?

A

GENETIC: Autosomal Dominant mutation of B-myosin heavy chain or myosin binding protein C

25
Q

How is dilated cardiomyopathy managed?

A

LV Assist device

Transplant

26
Q

What happens in hypertrophic cardiomyopathy?

A 
Enlarged LV
Leads to Hypercontractile walls
Intraventricular septum enlarges → stiff walls
↓ventricular space for blood → ↓SV
DIASTOLIC HF
27
Q

Why is intraventricular septal growth in hypertrophic cardiomyopathy an issue?

A

Narrows outflow to aorta
MN leaflet pulled towards septum
VENTURI EFFECT → Ejection systolic murmur
Sound increases w/valsalva manoeuvre

28
Q

What are the signs of hypertrophic cardiomyopathy?

A

Dyspnoea, syncope, angina
ECG: Signs of LVH- R wave progression, progressive T wave inversion, Large A waves
Double apex beat
Jerky pulse

29
Q

How is hypertrophic cardiomyopathy managed?

A

BB/CCB

Surgery

30
Q

What are the causes of restrictive cardiomyopathy?

A

Amyloidosis
Sarcoidosis
Post-RT (Fibrosis)
Haemochromatosis (Fe deposition in myocardium)

31
Q

How does restrictive cardiomyopathy occur?

A

Stiffening of muscle +/- hypertrophy
↓ventricular filling
DIASTOLIC HF

32
Q

How is restrictive cardiomyopathy managed?

A

Tx cause

Transplant

33
Q

What is heart block?

A

Conduction pathway abnormality (scarring, ageing, IHD)
Leads to slow conduction
AV node develops delayed response to SA impulse
Atrio-ventricular conduction abnormality

34
Q

What are the risk factors for heart block?

A 
Inferior MI
Well trained athletes
SLE
Lyme disease
Myocarditis
Meds (Flecainide, CCB, BB, Mg, Digoxin)
35
Q

On an ECG how is each degree of heart block differentiated?

A

1st: Prolonged PR
2ndT1: Prolonged PR, eventual QRS drop
2ndT2: Prolonged PR, regular QRS drops
3rd/Complete: Regular P waves, complete unconnected wide or narrow QRS rhythm, bradycardia

36
Q

How does each degree of heart block present?

A

1st: Asymptomatic
2nd: Dizzy, syncope, fatigue, chest pain, dyspnoea, palpitations (T2)
3rd: Bradycardia, cannon waves in JVP, confusion

37
Q

What is a Stokes Adam’s attack?

A

Sudden syncope without warning
LOC 5-20s
Associated w/complete heart block
ECG: Wide inverted T waves

38
Q

How is complete heart block managed?

A 
Bradycardia → follow bradycardia pathway
If adverse features: Shock, syncope, myocardial ischaemia, HF, sBP <90:
HELP
Defib on &amp; Lay flat w/legs ↑
500mcg IV Atropine w/large flush
ASSESS FOR RESPONSE:
YES = Consider risk of Asystole &amp; observe
NO = Consider following:
Atropine 500mcg IV 
OR
Transcutaneous pacing
OR
Adrenaline 2-10mcg IV
Isoprenaline 5mcg IV
39
Q

Which types of heart block require pacing?

A

Mobitz type 2

Complete

40
Q

If bradycardia is caused by a CCB or BB what medication should be given?

A

Glucagon

41
Q

What are the indications for risk of asystole?

A

Recent asystole
Mobitz type 2 AV block
Complete heart block w/broad QRS
Ventricular pause >3s

42
Q

What is bifascicular block?

A

RBBB w/L ant/post hemi-block:

RBBB w/L axis deviation

43
Q

What is trifascicular block?

A

Features of bifascicular block + 1st degree heart block

Yr 5 Cardiology (8 decks)

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