Cardiac failure Flashcards Preview

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Flashcards in Cardiac failure Deck (26)
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1
Q

Acute left ventricular failure

A

Left ventricle unable to adequately move blood through the left side of the heart and out into the body

2
Q

Triggers

A

Iatrogenic (aggressive IV fluids in frail elderly patients with impaired LVF)

Sepsis

MI

Arrhythmias

3
Q

Symptoms of acute LVF

A

Rapid onset breathlessness
- exacerbated by lying flat and improves on sitting up

Looking/ feeling unwell

Cough (frothy white/pink sputum)

4
Q

Acute LVF on examination

A

Increased RR

Reduced O2 sats

Tachycardia

3rd heart sound

Bilateral basal crackles

Hypotension in severe cases

5
Q

Blood gas for acute LVF

A

Type 1 respiratory failure
- low oxygen without increase in carbon dioxide

6
Q

Signs/symptoms if they also have right sided failure

A

Raised JVP

Peripheral oedema

7
Q

BNP

A

Hormone released from the ventricles when the myocardium is stretched beyond the normal range

8
Q

Action of BNP

A

Relax smooth muscle in blood vessels

Reduces systemic vascular resistance making it easier for the heart to pump blood through the system

Acts on kidneys as a diuretic to reduce circulating volume and improve function of heart

9
Q

Other causes of raised BNP

A

Tachycardia

Sepsis

PE

Renal impairment

COPD

10
Q

Use of ECHO

A

To measure left ventricular function by the ejection fraction

11
Q

Normal ejection fraction

A

Above 50%

12
Q

Chest xray findings

A

Cardiothoracic ratio >0.5

Upper lobe venous diversion

Bilateral pleural effusions

Fluid in interlobular fissures

Fluid in septal lines (Kerley lines)

13
Q

Management of acute LVF

A

Pour SOD

Pour away (stop) their fluids

Sit up

Oxygen if <95%

Diuretics

14
Q

Other management if severe acute pulmonary oedema or cardiogenic shock

A

IV opiates (act as vasodilators but not routinely recommended)

NIV (CPAP helps open airways to improve gas exchange)

If NIV doesn’t work they made need full intubation and ventilation

Inotropes to strengthen force of heart contractions

15
Q

Presentation of chronic heart failure

A

Breathlessness worsened by exertion

Cough (frothy white/ pink sputum)

Orthopnoea

PND

Peripheral oedema

16
Q

Paroxysmal nocturnal dyspnoea

A

Waking and feeling short of breath with a cough and wheeze

Fluid settling across large surface area as lying flat

Respiratory centres in brain become less responsive so RR and effort doesn’t increase in response to reduced O2 like it would awake

17
Q

Causes of chronic heart failure

A

IHD

Valvular heart disease

HTN

Arrhythmias

18
Q

Additional management for chronic heart failure patients

A

One off pneumococcal vaccine

Annual flu vaccine

Stop smoking

19
Q

First line medical management of chronic HF

A

ACEi and beta blocker

20
Q

Second line treatment

A

Aldosterone antagonist

Need to monitor potassium

21
Q

Third line treatment

A

Ivabradine

Salcubitril-valsartan

Digoxin

Hydralazine combination with nitrate

Cardiac resynchronisation therapy

22
Q

Ivabradine criteria

A

Sinus rhythm >75bpm and LVF <35%

23
Q

Sacubitril-valsartan criteria

A

LVF <35%

Considered in HF with reduced ejection fraction who are symptomatic on ACEi or ARBs

24
Q

Digoxin use

A

Not been proven to reduce mortality in patients with HF

May improve symptoms due to inotropic properties

Strongly indicated if co-existant af

25
Q

Hydralazine indication

A

Afro-Caribbean patients

26
Q

Cardiac resynchronisation therapy indication

A

Widened QRS complex on ECG