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Cardio > Chronic HF > Flashcards

Chronic HF Flashcards

1
Q

what is chronic heart failure?

A

clinical features of impaired heart function specifically the left ventricles function to pump blood through the heat and to the body

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2
Q

what does impaired left ventricle function cause?

A

chronic backlog of blood waiting to flow through the left side of the heart
backlog in left atrium, pulmonary veins and lungs = increased volume and pressure of blood

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3
Q

what causes pulmonary oedema?

A

backlog of blood in left atrium, pulmonary veins and lungs causes them to leak fluid and means they are unable to reabsorb fluid from the surrounding tissues = pulmonary oedema

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4
Q

what does eject fraction mean?

A

the percentage of blood squeezed out by the left ventricle with each ventricular contraction

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5
Q

what is a normal ejection fraction?

A

above 50%

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6
Q

what is heart failure with reduced ejection fraction?

A

when the ejection fraction is less than 50%

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7
Q

what is heart failure with preserved ejection fraction?

A

clinical signs of heart failure but the ejection fraction is still greater than 50%

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8
Q

what is heart failure with preserved ejection fraction a result of?

A

diastolic dysfunction
issues with the left ventricle filling during diastole (ventricle relaxing)

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9
Q

what are the causes of chronic heart failure?

A

ischaemic heart disease
valvular heart disease -commonly aortic stenosis
cardiomyopathy
arrhythmia - commonly atrial fibrillation
hypertension

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10
Q

how would a patient with chronic heart failure present?

A

breathlessness - worse on exertion
cough - white/pink frothy sputum
orthopnoea - breathlessness when lying flat that is relieved by sitting of standing
paroxysmal nocturnal dyspnoea
peripheral oedema
fatigue

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11
Q

what are clinical examination signs of chronic heart failure?

A

tachycardia
tachypnoea
murmurs - indicate valvular disease
3rd heart sound
bilateral basal crackles (wet sounding) - indicate peripheral oedema
raised JVP - caused by backlog on right side of heart leading to engorged internal jugular vein
peripheral oedema - ankles, legs, sacrum

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12
Q

what is paroxysmal nocturnal dyspnoea?

A

suddenly waking with severe shortness of breath, cough and wheeze

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13
Q

how might patents with paroxysmal nocturnal dyspnoea describe it feeling?

A

suffocation or drowning
may need to sit on side of bed or walk around
may need to open window for fresh air
often improves within several minutes

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14
Q

what are the proposed mechanisms of paroxysmal nocturnal dyspnoea?

A

1) when laying flat, the fluid settles across a large surface area of the lungs making the patient breathless, then when they stand up the fluid settles in the lung bases allowing the upper part of the lungs to function better
2) when asleep the respiratory centre in the brain is less responsive therefore when O2 saturation decreases the respiratory rate and effort does not increase like it would when awake allowing for increased and more severe pulmonary congestion and hypoxia before waking up feeling unwell
3) when asleep the adrenaline circulating in the body is decreased therefore the myocardium is more relaxed and therefore the cardiac output is lower

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15
Q

what does the assessment of chronic heart failure include?

A

clinical exam - history and physical exam
echocardiogram
ECG
N-terminal pro-B-type natriuretic peptide (Nt-proBNP) blood test

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16
Q

what other investigations may be done when assessing for chronic heart failure?

A

bloods to test for anaemia, renal, thyroid and liver function, lipids and diabetes
chest x-ray and lung function tests to exclude lung pathology

17
Q

what is the New York Heart Associations classification of chronic heart failure?

A

Class I - no limitation on activity
Class II - comfortable at rest but symptomatic with ordinary activity
Class III - comfortable at rest but symptomatic doing any activity
Class IV - symptomatic at rest

18
Q

how is chronic heart failure managed?

A

Refer to cardiology
Advise them about condition
Medical management
Procedural or surgical treatments
Specialist heart failure MDT input - i.e specialist HF nurses for advice and support

19
Q

what does the urgency of referral depend on?

A

Nt-proBNP test result:
400-2000ng/L should be seen and have an echocardiogram within 6 weeks
greater than 2000ng/L should be seen and have an echocardiogram within 2 weeks

20
Q

what are additional managements options for chronic heart failure?

A

flu, covid and pneumococcal vaccines
smoking cessation
optimise treatment of co-morbidities
written care plan
cardiac rehabilitation (personal exercise programme)

21
Q

what is the medical management if chronic heart failure?

A

ACEi - ramipril titrated as high as tolerated
Beta blocker - bisoprolol titrated as high as tolerated
Aldosterone antagonist - spironolactone or epelerenone
Loop diuretics - furosemide or bumetanide

22
Q

when are aldosterone antagonists used in the medical management of heart failure?

A

when there is a reduced ejection fraction and symptoms are not controlled by ACEi + beta blocker

23
Q

when would an ARB be used in medical management of heart failure?

A

instead of an ACEi when ACEi are not tolerated
i.e in valvular heart disease unless started by a specialist
ARB = candesartan

24
Q

what medications need Us&Es monitored and why?

A

ACEi
aldosterone atagonists
loop diuretics
can all cause electrolyte disturbances

25
Q

what medications must renal function be monitored for?

A

ACEi
aldosterone antagonists
both can cause hyperkalaemia

26
Q

what are additional specialist treatments of chronic heart failure?

A

SGLT2 inhibitor
sacubitril with valsartan ( brand name entresto)
ivabradine
hydralazine
digoxin

27
Q

what surgical and procedural management could be used for chronic HF?

A

surgery to treat underlying valvular disease
implantable carioverter defibrillator
cardiac resynchronisation therapy
heart transplant - for those suitable with severe disease

28
Q

how do implantable cardioverter defibrillators work?

A

they continually monitor the heart and apply a defibrillator shock to cardiovert the patient back into sinus rhythm if shockable arrhythmia is identified

29
Q

when are implantable cardioverter defibrillators used?

A

for patients with previous ventricular tachycardia or ventricular fibrillation

30
Q

when is cardiac resynchronisation therapy used?

A

in patients with severe diesease (EF less than 35%)

31
Q

what is cardiac resynchronisation therapy?

A

biventricle (triple chamber) pacemakers with leads in the RA RV and LV
the objective is to synchronise contraction in the chambers to optimise heart function

Cardio (4 decks)

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