Heart failure Flashcards
Definition
HF is a syndrome characterised by two things:
Abnormality of the function and structure of the heart - proved through imaging
Combined by symptoms of SOB and fluid retention
No longer meeting the demands of the body - e.g. anaemia or thyrotoxicosis
Main classification of HF
Ejection fraction
- we only use EF as a classification marker because certain drugs were trested
ACEi /ARB /Angiotension receptor neprolisin inhibitor
BB
MRA - spir
SGLT2 inhibitors
Neprolisin breaks down BNP.
BNP is released during right atrial strain, so they relieve this by:
Vasodilation and salt and water loss
Accumulating BNP increases vasodilation and natresis
Segubitril
see PARADIGM trial
However due to hypotension ARNI isn’t tolerated by all, so give ACEi instead
ARNI was shown to have a 20% improvement in outcomes compared to ACEi
Which drugs do you give for which HF patients
Mildly reduced EF - 41-49% - you can give all four drugs
Preserved EF 50+ EF - you can only give SGLT2 inhibitors - empa and dapaglifozin
How else can we classify heart failure
Acute, subacute, chronic
Subacute - slowly getting worse
Acute - cardiogenic shock causing low output, elevated lactate, cold peripheries - inotropes + mechanical pump needed
Signs of RHF and causes of pulmonary oedema
right sided HF - liver involvement, chronic venous insufficiency
Pulm oedema - sudden rise in LV filling pressures due to MV regurg
Treat with oxygen, CPAP, diuretics, IV GTN
Acute valvular problems
Acute
ECHO - once every year, or sooner if change in symptoms
Blood test
Life long medication
TRED EDGEF study
cardiac rehab
prognosis - 12 years
STRONG EDGE-F - optimising therapy in early stages (6w) is so important - live longer than if uptitration is slower
How to deal with a patient with decompensated HF even when they are on frusemide already
2L goes in
3kg goes out
Multiply diuretics by 3 when in hospital and give IV
Urinary spot sodium - if this level remains low even after frusemide (75mg/L) - this means their frusemide isn’t working
Note - frusi doesn’t improve symptoms
