Heart Failure Flashcards
(20 cards)
Defenition
failure of the heart to generate sufficient cardiac output to meet metabolic demands of the body
The four ways in which heart failure is classified
- Low-output HF vs High output HF
- Systolic vs Diastolic HF
- Acute vs Chronic HF
- New York Heart Association Classification of HF
How is Low-output HF vs High-output HF defined
Low-output HF
* cardiac output is reduced due to primary problem with the heart, so it cannot meed bodies needs
High-output HF
* heart that has normal cardiac output, but there is an increase in the bodies metabolic demands that the heart cannot meet
Low-output much more common
Causes of high-output HF - 6
AAPPTT mnemonic
Anaemia
Arteriovenous malformation
Paget’s disease
Pregnancy
Thyrotoxicosis
Thiamine deficiency (wet Beri-Beri)
Systolic vs Diastolic Heart failure definition
AKA reduced ejection fraction and preserved EF
Systolic dysfunction - ventricles can fill, but cannot contract sufficiently - reduced ejection fraction
Diastolic dysfunction - ventricles cannot relax and fill normally - preserved ejection fraction
Causes of systolic heart failure /HFrEF - 3
- IHD
- dilated cardiomyopathy
- mycarditis
Causes of diastolic heart failure / HFpEF - 3
- chronic HTN (bcos LV hypertrophy)
- hypertrophoc cardiomyopathy
- cardiac tamponade
New York Heart Association (NYHA) Classification of HF - 4
Class I - no limitation in physical activity, and activity does not cause undue fatigue, palpitation or dyspnoea.
Class II - slight limitation of physical activity, and comfort at rest. Ordinary physical activity causes fatigue, palpitation and/or dyspnoea.
Class III - marked limitation in physical activity, but comfort at rest. Minimal physical activity causes fatigue (less than ordinary).
Class IV - inability to carry on any physical activity without discomfort, with symptoms occurring at rest. If any activity takes place, discomfort increases.
Clinical features of left HF - 8
Causes pulmonary congestion (backup into lungs) and systemic hypoperfusion
- SOB on exertion
- Noctural dyspnoea
- Orthopnoea
- Pink frothy sputum
- fine crackles on lung auscultation
- cyanosis
- long cap refil
- hypotension
Clinical features of right HF - 6
Causes venous congestion and pulmonary hypoperfusion from reduced right heart output
- Ankle swelling and abdo swelling
- Anorexia and nausea
- raised JVp
- pitting oedema
- hepatomegaly
- transudative pleural effusion
Differentials of Heart failure - 4
COPD
ARDS
Renal failure
Liver failure
Investigations
- NT-pro-BNP Level (1st line)
- 12 lead ECG
- Bloods - U and E, LFTs, TFTs, lipid profile, glucose
- CXR
- Echo (looks at ejection fraction)
What are the ranges for BNP when measuring for HF
- below 400 - HF not likely
- 400-2000 - refer in less than 6 weeks
- over 2000 - refer for 2 weeks
What are the EF percentages from an echo that differentiate between HFrEF and HFpEF?
- if EF less than 40% - HFrEF (systolic dysfunction)
- if EF is more than 40% - HFpEF (diastolic dysfunction)
- EF 50%-70% with a normal BNP - normal
What are CXR findings of heart failure - ABCDEF
A: Alveolar oedema (with ‘batwing’ perihilar shadowing)
B: Kerley B lines (caused by interstitial oedema)
C: Cardiomegaly (cardiothoracic ratio >0.5)
D: upper lobe blood diversion
E: Pleural effusions (typically bilateral transudates)
F: Fluid in the horizontal fissure
Conservative management of heart failure - 5
- weight loss
- smoking cess
- salt and fluid restriction
- excercise based group rehab
- annual flu and pneumococcal vaccine
1st line medical Management of Heart failure - 6
1st line for all - Loop Diuretics e.g. fuorosemide
For HFpEF:
* manage co-morbidities
* cardiac rehab programme
For HFrEF
* ACEi and Beta blocker
* Consider ARB if intolerant to ACEi
* Consider hydralazine if intolerant to ACEi and ARB
Medications used if symtoms persist after initial medical management of heart failure - 5
- Aldosterone antagonists = spironolactone or eplerenone.
- Hydralazine and a nitrate for Afro-Caribbean patients.
Others:
- Ivabradine if in sinus rhythm and impaired EF.
- Digoxin = useful in those with AF
- SGLT2 inhibitors - dapgliflozin
What does the BASH mnemonic stand for
Medications that demonstrate mortality benefits in HFrEF:
Beta blockers
AceI
Sprionolactone
Hydralazine
Surgical management of HF
Cardiac resynchronisation therapy
ICDS (implantable cardioverter defibrillator) are indicated if following criteria fulfilled:
QRS interval <120ms, high risk sudden cardiac death, NYHA class I-III
QRS interval 120-149ms without LBBB, NYHA class I-III
QRS interval 120-149ms with LBBB, NYHA class I
