Heart failure Flashcards
What is the definition of heart failure?
Complex syndrome when the heart is unable to maintain circulation around the body, as a result of structural or functional impairment of ventricular filling or ejection
What is the ejection fraction for heart failure?
Ejection fraction - the total percentage of blood pumped out of the heart each heartbeat
Normal EF - above 50%
HF - less than 40% - heart is not pumping enough blood
How do you access symptomatic severity for heart failure?
The New York Heart Association (NYHA)
Class I - no limitation of physical activity - no fatigue/ breathlessness or palpitations
Class II - slight limitation of physical activity - physical activity results in undue b/ f/ p
Class III - marked limitation of physical activity/ comfortable at rest less than ordinary activity results in b/p/ f
Class IV - unable able to carry out any physical activity without discomfort
What are the typical symptoms of heart failure?
Breathlessness: on exertion, at rest, on lying flat (orthopnoea), nocturnal cough, or waking from sleep (paroxysmal nocturnal dyspnoea)
Fluid retention (ankle swelling, bloated feeling, abdominal swelling, or weight gain
Fatigue, decreased exercise tolerance, or increased recovery time after exercise.
Light headedness or history of syncope
What investigations are required to diagnose heart failure?
ECG
Consider chest x-ray/ blood tests/ urinalysis/ peak flow or spirometry
Measure NT-proBNP (Brain natriuretic peptide BNP) - released by ventricles in response to myocardial wall stress / proBNP - inactive protein releases BNP
What is the diagnosis of heart failure?
Brain natriuretic peptide (BNP) -
If the BNP level is above 400pg/mL or the NT-pro-BNP level is above 2000, refer for specialist assessment and echocardiography 2 weeks.
If the BNP level is between 100–400pg/mL or the NT-pro-BNP level is between 400–2000refer for specialist assessment and echocardiography to be seen within 6 weeks.
If BNP levels are normal (less than 100pg/mL [29pmol/L]) or NT-pro-BNP is less than 400pg/mL (47pmol/L), a diagnosis of heart failure is unlikely. Consider referral if a clinical suspicion of heart failure persists and conditions are present which may cause a false negative result.
Echocardiography is the gold standard investigation to confirm a diagnosis of heart failure
What are the complications of heart failure?
Cardiac arrhythmias - Atrial fibrillation/ ventricular arrhythmias
Depression
Cachexia
Chronic kidney disease
Sudden cardiac death
Diagnosis signs of heart failure
Tachycardia
Laterally displaced apex beat, heart murmurs, and third and fourth hart sounds (gallop rhythm)
Hypertension
Raised jugular venous pressure
Enlarged liver (due to engorgement)
Respiratory signs such as tachypnoea, basal crepitations, and peripheral effusions.
Dependent oedema (legs, sacrum), ascites
Obesity
What is the immediate management?
Review the patient’s medication - if necessary, stop / reduce drugs that worsen heart failure e.g CCH
symptoms severe - start loop diuretic e.g furosemide/ bumetanide/ torasemid
Arrange admission for server symptoms
Seek specialist advice - pregnant women
What is the Natriuretic peptide levels reduced by?
BMI greater than 35 kg/m2
Drugs including diuretics/ angiotensin-converting enzyme (ACE) inhibitors/ beta blockers + aldosterone antagonists (spironolactone)
How are natriuretic peptide levels reduced?
BMI greater than 35 kg/m2
Medication including diuretics/ angiotensin-converting enzyme (ACE inhibitor) + aldosterone antagonist ( e.g spironolactone)
How are natriuretic peptide (BNP) levels increased?
age over 70/ female / pulomnary embolism + hypertension/ chronic kidney disease/ sepsis/ diabetes/ liver cirrhosis
What is the management of heart failure?
1) Offer diuretics for congestive symptoms + fluid retention (fluid overload - severe loop diuretic e.g furosemide/ bumetanide etc)
2) Reduced ejection fraction of below 40% - offer ACE inhibitors + BB (angiotensin converting enzyme)
MRA if symptoms continue
Consider ARD if intolerant of ACE
3) Personalised cardiac rehabilitation
What are loop diuretics?
The loop diuretic is used for the relief of congestive symptoms and fluid retention in people with heart failure, and titrated (up and down) according to need
What is long term management for heart failure?
ACE inhibitors - decrease morbidity and mortality pt’s with left ventricular dysfunction - asy + sym
Pt’s chronic HF recivee BB once established ACE
