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General med - Cardiovascular > Heart failure > Flashcards

Heart failure Flashcards

(55 cards)

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1
Q

Raised levels of which parameter is indicative of a poor prognosis in heart failure

A

N-terminal pro-B-type natriuretic peptide

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2
Q

When should patients with a high NT-proBNP be referred

A

Patients with suspected heart failure and an NT-proBNP level above 2,000 ng/litre should be referred urgently to have a specialist assessment and transthoracic echocardiography within 2 weeks

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3
Q

Which factors can reduce levels of serum natriuretic peptides

A

Obesity
African or African-Caribbean family origin
Diuretics
ACE inhibitors, beta blockers and ARBs

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4
Q

Causes of raised serum natriuretic peptides besides heart failure

A 
Age over 70 years 
Left ventricular hypertrophy 
Ischaemia
Tachycardia 
Right ventricular overload 
Hypoxaemia(from PE) 
Renal dysfunction
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5
Q

1st line treatment for heart failure with reduced ejection fraction

A

ACE inhibitor + beta blocker

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6
Q

When should ACE inhibitors not be offered in suspected heart failure

A

If there is also clinical suspicion of a haemodynamically significant valve disease until it has been assessed by a specialist

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7
Q

Which parameters should be measured and monitored in ACE inhibitor therapy

A

Serum sodium and potassium
Renal function and blood pressure
Before and 1 to 2 weeks after starting an ACE inhibitor, and after each dose increment

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8
Q

Alternative to ACE inhibitors in treatment of heart failure with reduced ejection fraction

A

ARB

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9
Q

Alternative to ACE inhibitors and ARBs in treatment of heart failure with reduced ejection fraction

A

Consider hydralazine in combination with nitrate for people who have heart failure with reduced ejection fraction

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10
Q

Which medication can be added to patients who continue to have heart failure with reduced ejection fraction already on ACE inhibitors(or ARB) and a beta-blocker

A

Mineralocorticoid receptor antagonists

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11
Q

When is ivabradine recommended in management of chronic heart failure

A

NYHA class II to IV stable chronic heart failure with systolic dysfunction

Sinus rhythm with a HR of 75bpm or more

Combination with standard therapy

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12
Q

When is sacubitril valsartan recommended in management of chronic heart failure

A

NYHA class II to IV symptoms

Left ventricular ejection fraction of 35% or less

Patients are already taking a stable dose of angiotensin-converting enzyme(ACE) inhibitors or ARBs

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13
Q

When is digoxin recommended in management of chronic heart failure

A

Recommended for worsening or severe heart failure with reduced ejection fraction despite first-line treatment for heart failure

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14
Q

Why should response to medicines be closely monitored in patients with CKD and heart failure with reduced ejection fraction

A

Increased risk of hyperkalaemia

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15
Q

Management of heart failure with a preserved ejection fraction

A

Loop diuretics
Ca2+ blockers
Amiodarone

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16
Q

Which parameters should be tested in people taking amiodarone

A

Liver and thyroid function tests

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17
Q

Advice regarding vaccinations in people with heart failure

A

Offer annual vaccination against influenza

Vaccination against pneumococcal disease

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18
Q

Advice regarding salt and fluid restriction in people with heart failure

A

No need to routinely advise people to restrict sodium or fluid consumption

Restrict fluids for people with dilutional hyponatraemia

Reduce intake for people with high levels of salt and/or fluid consumption

Advise to avoid salt substitutes that contain potassium

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19
Q

Interventional procedures for heart failure

A

Coronary revascularisation(not routinely offered for people with reduced ejection fraction)

Cardiac transplantation(only if severe refractory symptoms or refractory cardiogenic shock)

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20
Q

Non-pharmacological interventions in management of heart failure

A

Implantable cardioverter defib and cardiac resychronisation therapy

Cardiac rehabilitation

Palliative care

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21
Q

Types of heart failure

A

Systolic/diastolic
Right-sided/Left-sided
High-output

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22
Q

What does systolic heart failure refer to

A

Inability of the myocardium to generate a sufficient cardiac output due to left ventricle not being able to contract completely

AKA heart failure with reduced ejection fraction

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23
Q

Formula for cardiac output

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A

CO = Heart rate x Stroke volume

24
Q

What is stroke volume dependent on

Study These Flashcards
A

Preload
Contractility
Afterload(inverse)

25
Definition of preload
Initial stretching of the cardiac myocytes prior to contraction
26
Definition of afterload
Pressure against which the heart must work to eject blood during systole(systolic pressure) The lower the afterload, the more blood the heart will eject with each contraction
27
Conditions which affect contractility which leads to systolic HF
``` Myocardial infarction(Anterior/Lat esp) Dilated cardiomyopathy ```
28
Conditions which cause an increased preload with a background of reduced contractility leading to systolic HF
Mitral regurgitation | Aortic regurgitation
29
Definition of diastolic heart failure
Preserved left ventricular function characterised by a stiff left ventricle with decreased compliance and impaired relaxation which leads to increased end diastolic pressure
30
Conditions which reduce preload causing diastolic heart failure
MI Restrictive cardiomyopathy(amyloidosis) Constrictive pericarditis
31
Conditions which increase afterload causing diastolic heart failure
Hypertension Aortic stenosis Coarctation of aorta Hypertrophic obstructive cardiomyopathy
32
Causes of increased afterload leading to right sided heart failure
Pulmonic stenosis Pulmonary hypertension Pulmonary embolism Cor pulmonale secondary to COPD/underlying lung disease
33
Causes of increased preload with a background of reduced contractility leading to right sided heart failure
Pulmonary regurgitation | Tricuspid regurgitation
34
Causes of reduced contractility leading to right sided heart failure
``` Inferior MI (II, III, aVF) Myocarditis ```
35
Most common cause of right sided heart failure
Left sided heart failure
36
What is high output cardiac failure
When there is normal cardiac function but it is still insufficient to supply the demand of the body
37
Causes of high output heart failure
Severe anaemia Thiamine deficiency(wet beri beri) Thyrotoxicosis
38
Which population is prone to thiamine deficiency
Chronic alcoholics
39
How does thiamine deficiency lead to high output cardiac failure
Inhibition of pyruvate dehydrogenase leading to accumulation of pyruvate which causes a build up of lactic acid Lactic acid causes vasodilation of arterioles which leads to AV shunting
40
What is paroxysmal nocturnal dyspnoea
Experience of suddenly waking at night with a severe attack of SOB and cough Symptoms improve after a few mins
41
What causes PND
Fluid settles across a large surface area of lungs during sleep which sinks to lung bases and upper lungs become clear on standing up Respiratory centre becomes less responsive during sleep so effort does not increase in response to reduced o2 sats --> pulmonary congestion and hypoxia Less adrenaline circulating during sleep meaning that myocardium is more relaxed and reduces cardiac output
42
First line medical treatment of chronic heart failure (ABAL)
``` ACE inhibitor(ramipril) Beta blocker(bisoprolol) Aldosterone antagonist(spironolactone) Loop diuretics(furosemide) ```
43
In which patients should ACE inhibitors be avoided
Patients with valvular heart disease
44
When are aldosterone antagonists used in heart failure
When there is reduced ejection fraction and symptoms are not controlled with an ACEi and beta blocker
45
What is cor pulmonale
Right sided heart failure caused by respiratory disease Increased pressure and resistance in pulmonary arteries results in right ventricle being unable to effectively pump blood out of the ventricle and into the pulmonary arteries
46
Respiratory causes of cor pulmonale
``` COPD(most common) PE Interstitial lung disease Cystic fibrosis Pulmonary pulmonary hypertension ```
47
Presentation of cor pulmonale
``` Hypoxia Cyanosis Raised JVP Peripheral oedema Third heart sound Murmurs Hepatomegaly due to back pressure in hepatic vein ```
48
Second-line treatment for heart failure
Aldosterone antagonist such as spironolactone and eplerenone should be remembered that both ACE inhibitors (which the patient is likely to already be on) and aldosterone antagonists both cause hyperkalaemia - therefore potassium should be monitored
49
When is ivabradine recommended in heart failure management
sinus rhythm > 75/min and a left ventricular fraction < 35%
50
When is digoxin indicated in heart failure management
digoxin has also not been proven to reduce mortality in patients with heart failure. It may however improve symptoms due to its inotropic properties it is strongly indicated if there is coexistent atrial fibrillation
51
In which group of patients may hydralazine in combination with nitrate be particularly effective
Afro-caribbean patients
52
Indications for cardiac resynch therapy
indications include a widened QRS (e.g. left bundle branch block) complex on ECG
53
Most common precipitating causes of acute heart failure
Acute coronary syndrome Hypertensive crisis Acute arrhythmia Valvular disease
54
Causes of de-novo acute heart failure
De-novo heart failure is caused by and increased cardiac filling pressures and myocardial dysfunction usually as a result of ischaemia. This causes reduced cardiac output and therefore hypoperfusion. This, in turn can cause pulmonary oedema. Other less common causes of de-novo AHF are: Viral myopathy Toxins Valve dysfunction
55
Factors which decrease BNP
Obesity Diuretics ACE inhibitors Beta-blockers

General med - Cardiovascular (13 decks)

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