chronic heart failure Flashcards
(22 cards)
chronic heart failure features
dyspnoea
cough - worse at night, pink frothy sputum
paroxysmal nocturnal dyspnoea
wheeze (“cardiac wheeze
weight loss -> “cardiac cachexia”
signs of right sided HF
- raised JVP, ankle oedema
- hepatomegaly
first line investigation for chronic heart failure
NT-proBNP
(N-terminal pro-B-type natriuretiic peptide)
if high -> specialist assessment (incl transthoracic echocardiography) within 2 weeks
if raised -> same as above but within 6weeks
what is BNP
a hormone produced mainly by the left ventricular myocardium in response to strain
- v high levels assoc with poor prognosis
- loadsss of things raise it
things that decrease BNP levels
obesity
diuretic
ACEi, beta blockers, ARBs
aldosterone antagonists
chronic heart failure classification
the New York Heart Association (NYHA)
I = no sx, no limitations
II = mild sx, slight lim of activities
III = mod sx, comfy at rest but less than ordinary activity levels
IV = severe sx, sx at rest, discomfort with physical activity
heart failure by ejection fraction
measured by echo
reduced EF = <35-40%
-> HF-rEF
presevered ejection fraction = HF-pEF
(50/50 what patient have)
do HF-rEF typically have systolic or diastolic dysfunction? what are causes of this?
systolic dysfunction! = impared myocardial contraction during systole
- iscahemic heart disease
- dilated cardiomyopathy
- myocarditis
- arrhythmias
do HF-pEF typically have systolic or diastolic dysfunction? what are causes of this?
diastolic! = impaired ventricular filling during diastole
- hypertrophic obstructive cardiomyopathy
- restrictive cardiomyopathy
- cardiac tamponade
- constrictive pericarditis
Which sided heart failure do HF-rEF + HF-pEF typically devlop? why does this happen?
Left sided heart failure
may be due to -
- increased LV afterload - arterial hypertension, aortic stenosis
- increased LV preload - aortic regurg resulting in backflow to LV
causes by right sided heart failure
either;
- increased RV afterload - pulmonary hypertension
- increased RV preload - tricuspid regurg
left ventricular heart failure presentation
pulmonary oedema !!
- dyspnoea
- orthopnoea
- paroxysmal nocturnal dyspnoea
- bibasal fine crackles
right ventricular heart failure presentation
Peripheral oedema - ankle/sacral
raised JVP
hepatomegaly
weight gain - due to fluid retention
anorexia - cardiac cachexia
high output heart failure + causes
where “normal” heart is unable to pump enough blood to meet metabolic needs of the body
causes
- anaemia
- ateriovenous malformation
- pagets disease
- pregnancy
- thyrotoxicosis
- thiamine deficiency
first line tx for heart failure patients
ACEi + betablocker
- one drug started at a time
these have NO effect on mortality in heart failure with preserved ejection fraction
types of beta blockers used in heart failure
bisoprolol
carvedilol
nebivolol
second line tx for heart failure
aldosterone antagonist
- spironolactone + eplerenone
- (these and ACEi cause hyperkalaemia -> monitor)
SGLT-2 inhibitors (if rEF)
- canagliflozin, dapagliflozin
third line tx of heart failure and their criterias for initiating
ivabradine
- criteria = sinus rhythm >75 + LV fraction <35%
sacubitril-valsartan
- criteria = LV frac <35%
- initiated AFTER ACEi or ARB wash out period
digoxin
- if coexistant AF
hydralazine in combo with nitrate
- esp in Afro-caribbean patients
cardiac resynchronisation tx
- if widened QRS (LBBB) on ecg
vaccines offered to heart failure patients
annual influenza vaccine
one-off pneumococcal vaccine
when might cardiac resynchronisation therapy be used in heart failure
if also **wide QRS **
- improves symptoms + reduces hospitalisation in NYHA class III patients
in which patient group would hydralazine in combination with nitrate be a good 3rd line tx for heart failure
afro-caribbean patients
criteria for initiating ivabradine
criteria:
- sinus rhythm > 75/min
- left ventricular fraction < 35%
drug that has only been demonstrated to improve mortality in patients with NYHA class III or IV heart failure who are already taking an ACE inhibitor
Spironolactone
