Chapter 2 - Heart Failure Flashcards
What is heart failure?
A progressive condition that is caused by structural or functional abnormalities of the heart, resulting in a reduced cardiac output
What are the symptoms and signs of heart failure?
Symptoms: SOB Persistent cough Ankle swelling Wheezing Fatigue Reduced exercise tolerance
Signs:
Raised jugular venous pressure
Pulmonary oedema
Pulmonary crackles
What are the two types of heart failure?
HFrEF - the left ventricle loses its ability to contract
HFpEF - the left ventricle loses its ability to relax
What is the NYHA classification tool for heart failure?
New York Heart Association
This classifies heart failure based on a patients symptoms and how much they are limited by exercise
What is the lifestyle advice for patients with heart failure?
Smoking cessation
Reduce alcohol constantly
Increase exercise
Weight management (patients should weigh themselves daily and contact GP if they gain more than 1.5-2kg in 2 days as this indicates worsening heart failure
Dietary changes (restrict salt and fluids)
Are CCBs used in heart failure?
No, they because they can reduce cardiac contractility
When can CCBs be used in heart failure?
Amlodipine can be safely used in patients with heart failure and angina
When are diuretics used in heart failure?
For breathlessness and odema
Which diuretics are used in heart failure?
Loop e.g. furosemide
Thiazides can be used if eGFR >30ml/min
What are some risks associated with the use of diuretics in heart failure?
Dehydration
Renal impairment
Hypotension
Which beta-blockers are licensed in heart failure?
Bisoprolol
Carvedilol
Nebivolol
Which ARBs are licensed in heard failure?
Losartan
Candesartan
Valsartan
Should you used the combination of an ACE Inhibitor and a potassium sparing diuretic for heart failure?
Usually this combination is not recommended - due to an increased risk of hyperkalaemia
But in heart failure, a low dose spironolactone may be beneficial - monitor potassium
Should you used the combination of an ACE Inhibitor and a loop diuretic for heart failure?
This may cause first dose hypotension if the dose of loop diuretic is >80mg furosemide or equivalent - monitor the patient
This risk can be reduced by temporarily reducing the diuretic dose, but this may cause severe rebound pulmonary odema
When are aldosterone antagonists used in heart failure and give some examples
When symptoms persist or worsen despite optimal first line treatment
Examples include spironolactone, eplerenone
When are aldosterone antagonists cautioned/contraindicated?
Hyperkalaemia
Renal impairment
When is digoxin used in heart failure?
When symptoms persist despite optimal treatment
For patients in sinus rhythm
What treatments are available for heart failure and when are they used?
First line: ACEi/ARB and beta-blocker
If breathlessness and odema occur: diuretic (loop)
If symptoms persist despite optimal first line treatment: aldosterone antagonist, digoxin (if in sinus rhythm)
What are the indications of spironolactone and eplerenone?
Spironolactone - HF, odema, resistant hypertension
Eplerenone - only HF
What are the main side effects of aldosterone antagonists?
AKI
Hyperkalaemia
Many more
What monitoring is associated with aldosterone antagonists?
Renal function and electrolytes
When do you use ivabradine in heart failure?
Severe chronic heart failure that after BB, ACEI and aldosterone antagonists have failed
In patients in sinus rhythm
HR >75bpm
What diuretic is used in acute heart failure?
IV furosemide
What diuretics are used in chronic heart failure?
How do you convert between these?
Furosemide
Bumetanide
Furosemide 40mg = bumetanide 1mg
