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4th Year CCC > Heart failure > Flashcards

Heart failure Flashcards

1
Q

It is the end stage of ______

A

All heart diseases

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2
Q

Definition of HF

A

Ability of the heart to maintain circulation is impaired due to a structural or functional impairment of ventricular filling or ejection

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3
Q

what are the two categories of HF?

A

Preserved and reduced ejection fraction

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4
Q

What is reduced ejection fraction HF?

A

<40%

Systolic dysfunction

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5
Q

What is preserved ejection fraction HF?

A

50-70%

Preserved systolic function

Clinical signs but LV and valves are normal

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6
Q

Classification used for HF

A

New york

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7
Q

most common underlying cause

A

CAD

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8
Q

5ys rate

A

about 50%

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9
Q

Risk factors

A

HTN, DM, AF, MI, angina

FHx

Drugs and alcohol

chemo in past

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10
Q

Investigation depends on what?

A

Prev MI or not

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11
Q

Investigation specifically if in no previous MI?

A

Measure BNP:

> 400- 2w referral to cardiology and echo

100-400- 6w referral

<100- HF unlikely

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12
Q

Investigation specifically if previous MI

A

Refer straight to cardiology and echo

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13
Q

Investigations to be done in all?

A

12L ECG

CXR

Bloods (U+E, Cr, FBC, TFT, LFT, HbA1c, lipids)

Urinalysis (for blood and protein- if they have CKD as well v bad)

Lung function (peak flow or spiro)

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14
Q

What might ECG show

A

Left axis deviation

LVH (V1 tall R wave, V6 deep S wave)

Previous MI (thick Q wave, inverted T wave, ST depression)

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15
Q

What symptom control can you give while awaiting test results?

A

Loop diuretic

Furosemide 20-40mg

Also review medication

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16
Q

How reliable is BNP?

A

It can be raised or lowered by other things

17
Q

What can BNP be reduced by?

A

High BMI

Some drugs (diuretic, ACEi, ARB, beta blocker, aldosterone antagonists e.g. spironolactone)

18
Q

What can BNP be elevated by?

A

> 70y

Female

LVH

Myocardial ischaemia

Tachycardia

Hypoxia

Pulmonary HTN

PE

CKD

Sepsis

COPD

DM

Liver cirrhosis

19
Q

Why are NSAIDs bad in HF?

A

Increase fluid retention and nephrotoxic

20
Q

Why should CCBs be avoided in HF due to systolic dysfunction?

A

negative inotropic effects may exacerbate the disease.

21
Q

management of reduced ejection fraction HF

A
  1. Review drugs that may cause or worsen
  2. Loop diuretic
  3. ACEi (or ARB) (titrate to maximum tolerated dose)
  4. beta blocker (bisoprolol) (titrate to maximum tolerated dose)
  5. Consider:
    - Antiplatelet if atherosclerosis
    - Statin
22
Q

How do ACEi help HF

A

Reduce preload and reduce SVR for easier after load

23
Q

How do beta blockers help?

A

Make heart beat slower- so protective against chronic sympathetic stimulation

24
Q

Do you start the ACEi and beta blocker at the same time?

A

No

25
Q

What other things can you consider for broader management?

A
  • Manage causes/comorbidities
  • Depression screen
  • Group exercise rehab referral
  • ACP
  • Nutrition
26
Q

Management for preserved ejection fraction HF?

A
  1. Review meds
  2. Loop diuretic (up to 80mg furosemide)
  3. Refer
  4. Consider antiplatelet or statin
27
Q

Do people with HF get extra vaccines?

A

Flu and pneumococcal

28
Q

What exercise is recommended in HF?

A

Regular low intesity

29
Q

What should a heart failure review include?

A
  1. Symptom check
  2. Updated NHYA classification
  3. Pulse rate and rhythm (–> ecg if abnormal or if syncope symptoms, or symptoms deteriorated)
  4. Fluid status (weight (and do BMI), listen to chest, oedema, hepatomegaly, postural drop in BP, JVP)
  5. Function, cognition, psychosocial needs, nutritional status, depression screen
  6. Review meds, up to date vaccines
  7. Bloods- U+Es, eGFR, creatinine, HbA1c, lipids
30
Q

How often should you review them

A

6months

31
Q

What advice can you give hf patients about managing their condition (8)

A
  1. Recognising symptoms and when to seek help
  2. Monitor body weight
  3. Keep active
  4. Smoking and alcohol
  5. Restrict salt consumption (just avoid excess, no specific guidance)
  6. Avoid excessive fluid intake
  7. Symptoms of dehydration
  8. Vaccines
32
Q

What are the driving rules for heart failure?

A

Continue as long as no symptoms distract, don’t need to inform DVLA

Lorries- disqualified if symptomatic (may be relicensed following tests)

Check with insurer that still covered

4th Year CCC (19 decks)

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