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Flashcards in FN: Chronic Heart Failure Deck (29):
1

Diagnosis of CCF

Famingham Criteria
2 major criteria or 1 major + 2 minor

2

Major criteria

PND
+ve abdominojugular reflux
Neck vein distension
S3
Basal creps
Cardiomegaly
Acute pulmonary oedema
Increase CVP (>16cm h20)
Wt. oss >4.5 kg in 5d secondary to treatment

3

Minor criteria

Bila ankle oedema
SOBOE
Increased HR >120
Nocturnal cough
Hepatomegaly
Pleural effusion
30% reduced vital capacity

4

Investigations

Bloods
CXR
ECG
Echo

5

Bloods included

FBC
U ad E
TFTs
Glucose lipids
BNP or NTproBNP

6

CXR

ABCDE
A - alveolar shadowing
Kerly B lines
Cardiomegaly (cardiothoracic ratio >50%)
Upper lobe Diversion
Effusions
Fluid in the fissures

7

ECG

Ischaemia
Hypertrophy
AF

8

Echo

The key investigation
1. Global systolic and diastolic function - ejection fraction normally - 60%
2. Focal/global hypokinesia
3. Hypertrophy
4. Valve lesions
5. Intracardiac shunts

9

B-ype Natriuretic Peptide: BNP or NtproBNP secreted from

Ventricles in response to
Increase pressure - stretch
Tachycardia
Glucocorticoids
Thyroid hormones

10

B-ype Natriuretic Peptide: Actions

1. Increase GFR and reduced renal Na reabsorption
2.Redcued preload by relaxing smooth muscle

11

BNP is a biomaker of

Heart Failure

12

BNP markers

Increased BNP (>100) better than any other variable and clinical judgement in diagnosing heart failure

13

BNP correlates with

LV dysfunction
i.e. increase most in decompensated heart failure
Increased BNP = increased mortality

14

BP <100 exlcudes

heart failure (96% NPV)

15

BNP also increases in

RHF: cor pulmonale, PE

16

New york Heart Association Classification

1. No limitation of activity
2. Comfortable @ rest, dyspnoea on ordinary activity
3. Marked limitation of ordinary activity
4. Dyspnoea @ rest, all activity - discomfort

17

General Management

Primary/Secondary Cardiovascular risk
1. Stop smoking
2. REduced salt intake
3. Optimise wt:: increase or decrease - dietician
Supervised group exercised based rehab programme
4. Aspirin
5. Statins

18

Treatment percipitants/Causes

Underlying cause:
1. Valve disease
2. Arrhythmias
3. Ischaemia

Exacerbating factors
1. Anaemia
2. Infection
3. Increase BP

19

Specific Management

ACEi
Beta blocker
Diuretics
Spironolactone
Digoxin
Vasodilators

20

ACEi/ARB:

e.g. lisinorpil or candesartan (if there is a cough

21

If patient intolerant to CE-i and ARBs (vasodilators)

Hydralazine + ISDN - also reduces mortality when added to standard therapy (including ACE-i) in Black patients with heart Failure.

22

Beta blockers

Carvedilol (3.125 mg/12h) or bisoprolol (start low and go slow)
Switch stable pts taking a beta blockers for a comorbidity to a beta blocker licensed for heart failure

23

Loop diuretic

Frusemide (40 mg) or bumetanide

24

Spiromolactone/eplerenone

Watch K carefully (on ACEi too)

25

1st line

ACEi/ARB
beta blocker
Loop diuretic

26

2nd line

Spiroolactone/eplerenone
ACEi + ARB
Vasodilators

27

3rd line

Digoxin
Cardiac resynchronisation therapy ± ICD

28

Other considerations

Monitoring:
1. BP: may be very low
2. Renal function
3. Plasma K
4. Daily wt

Use amlodipine for comorbid HTN or angina
Avoid verapamil, diltiazem and nifedipine (short acting)

29

Invasive therapies

Cardiac resynchronisation ± ICD
Intra-aortic balloon counterpulsation
LVAD
Heart transplant (70% 5 yrs)

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