CVS 10 Heart Failure - Investiagtions + Management Flashcards
(35 cards)
what classification system is used to classify heart failure?
new york heart association
Describe Class I heart failure
No symptomatic limitation of physical activity
Describe Class II heart failure
Slight limitation of physical activity
Ordinary physical activity results in symptoms
No symptoms at rest
Describe Class III heart failure
- Marked limitation of physical activity
- Less than ordinary physical activity results in symptoms
- No symptoms at rest
Describe Class IV heart failure
- Inability to carry out physical activity without symptoms
- May have symptoms at rest
- Discomfort increases with any degree of physical activity
Types of management of heart failure
- Symptomatic treatment - furosemide
- Prognostic treatment - HFrEF only
Acute management of heart failure
- IV furosemide
- O2 if needed
- GTN if severe hypertension or mitral/aortic reguritation
- CPAP if resp failure
Effect of IV furosemide
Venodilatory effect immediately
Onset diuretic action 30 mins, peaks 60-90mins - decreases circulating volume > decreases afterload > increases CO
Monitoring of IV furosemide
HR
BP
CXR
pO2
U&Es
Fluid balance
Hourly urine output
Daily weights - 1kg loss per day aim
Effects of beta blockers
Decrease HR
Decrease BP - reduced CO > lower O2 demand
Reduced mobilisation of glycogen
Negate unwanted effects of catecholamines
Investigations for heart failure
- Echocardiogram (gold standard)
- bloods: FBC, U&Es, TFTs, LFTs, lipids, diabetes
- BNP (acute)
- NT-proBNP (chronic)
- ECG
- ABG
- CXR
Why do you want to check for anaemia on a FBC in relation to heart failure?
Anaemia can worsen heart failure
Increased work of heart to meet O2 demand
What is brain natriuretic peptide produced by?
Stretching of ventricles
To try reduce BP by increasing Na + fluid loss
What level of BNP indicates myocardial damage?
> 100mg/L
Management of acute left ventricular failure
- sit up
- O2
- diuretics
- stop IV fluids
- identify underlying cause
- monitor fluid balance
- inotropes + vasopressors if needed
Diagnosis of chronic heart failure
- first line: NT proBNP blood test
- if high: specialist assessment incl transthoracic echo in 2 weeks
- if raised: in 6 weeks
urgency of referral + specialist assessment (echo) in heart failure depending on NT-proBNP
- 400-2000ng/L: within 6 weeks
- >2000ng/L: within 2 weeks
BNP vs NT-proBNP
- BNP has a short half life - 20mins-1hour > used ina cute settings
- NT-proBNP has a longer half life > more stabile in circulation > preferred in OP or chronic heart failure
What can increase BNP?
- LV hypertrophy
- ischaemia
- RV overload
- > 70 years old
- sepsis
- COPD
- GFR <60
What can decrease BNP?
- obesity
- diuretics
- ACEi
- B blockers
- aldosterone antagonists
Patient presents with symptoms of heart failure at rest, what classification of heart failure is this?
Class IV
Non pharmacological treatment of chronic heart failure
- reduce salt + liquid intake
- avoid salt substitutes
- reduce alcohol
- smoking cessation
- written care plan
- cardiac rehabilitation (personalised exercise plan)
- optimite treatment of co-morbidities
What is the mechanism of action of Sacubitril?
What drug is it often co prescribed with?
- neprilysin inhibition
- inhibitors natriuretic inactivating enzyme > increases effects of ANP/BNP > natriueiss
- stops bradykinin breakdown > vasodilation
. - valsartan (ARB)
What addition meds can be given is first line treatment of heart failure isn’t successful
- SGLT2 inhibitors e.g. dapaglifozin
- Sacubitril valsartan
- ivabradine
- digoxin
- hydralazine + nitrate (especially if Afro-Caribbean)
