HEART FAILURE Flashcards
What is heart failure?
The heart is unable to produce adequate cardiac output to meet the body’s metabolic requirements
NYHA classification of heart failure
Class I- No limitation of activity
Class II- Slight limitation of activity
Class III-Marked limitation of activity
Class IV- Unable to carry out any physical activity without discomfort, symptoms at rest
Causes of heart failure
Hypertension
Pulmonary hypertension
Rheumatic heart disease
Ischaemic heart disease
Congenital heart disease
Cardiomyopathies
Cardiac arrhythmia
Severe anaemia
Thyrotoxicosis
Symptoms of left heart failure
- Breathlessness
On exertion
On lying flat (orthopnoea)
At night (paroxysmal nocturnal dyspnoea) - Easy fatiguability
- Cough
- Wheezing
Nature of sputum in heart failure
frothy blood-stained sputum
Symptoms of right heart failure include
Swelling of the feet and lower extremities
Abdominal swelling
Right hypochondrial pain from an enlarging liver
Which symptom of heart failure may be absent in children below six months of age
Pitting pedal edema
Signs of left heart failure
Tachypnoea
Tachycardia
Basal crepitations
Gallop rhythm
Displaced apex beat
Cardiac murmur
Rhonchi
Signs of right heart failure
Tachycardia
Pitting pedal oedema
Ascites
Tender, smooth, soft hepatomegaly
Raised jugular venous pressure
Gallop rhythm
Cardiac murmur
Signs present in both left and right heart failure
Gallop rhythm
Tachycardia
Cardiac murmur
Signs of heart failure in children
Failure to thrive
Difficulty in feeding
Investigations in heart failure
FBC
BUE/Cr
ECG
Echocardiography
Chest X-ray
LFT
Fasting blood sugar
Fasting lipid profile
TFT
Cardiac enzymes
Coronary angiography
When is cardiac enzyme test needed in heart failure
When there is suspicion of myocardial infarction
Treatment objectives in heart failure
To relieve symptoms and improve quality of life
To treat the precipitating cause
To treat complications
To prevent recurrence of symptoms
To reduce need for hospital re-admissions
To reduce mortality
Non-pharmacological treatment of heart failure
Reduce salt intake
Weight reduction
Avoid alcohol
Avoid or quit smoking
Encourage moderate exercise
Bed rest
Prop in bed
When is bed rest needed in heart failure patient
acute heart failure or exacerbations of chronic heart
failure
Initial treatment of acute heart failure
Oxygen if SpO2 < 90%
And
Furosemide, IV,
Adults
40-80 mg, repeat after 30 minutes if necessary
Children
12-18 years; 20-40 mg repeated 8 hourly as necessary
1 month-12 years; 0.5-1 mg/kg repeated 8 hourly (max 4 mg/
kg/dose)
Maintenace treatment of acute heart failure patients after treatment
Furosemide, IV,
Adults
40-80 mg 12 hourly
Children
12-18 years; 20-40 mg repeated 8 hourly as necessary
1 month-12 years; 0.5-1 mg/kg repeated 8 hourly (max 4 mg/
kg/dose)
Dose of furosemide for initial treatment of acute heart failure
Furosemide, IV,
Adults
40-80 mg, repeat after 30 minutes if necessary
Children
12-18 years; 20-40 mg repeated 8 hourly as necessary
1 month-12 years; 0.5-1 mg/kg repeated 8 hourly (max 4 mg/kg/dose)
Next step in treatment if patient is not improving after initial treatment
Furosemide
and
IV Morphine
and
IV Metoclopramide
Morphine can be used for heart failure in children T/F
False
Treatment of acute heart failure patients who are improving after initial treatment
Furosemide, oral,
Adults
40-80 mg 12 hourly
Children
0.5-2 mg/kg 8-12 hourly
Treatment of acute heart failure with fast atrial fibrillation or in sinus rhythm with systolic dysfunction
Digoxin oral
Elderly
125 micrograms 12 hourly for 24-48 hours
Adults
250 micrograms 12 hourly for 24-48 hours
Then
250 micrograms daily
Then
125 micrograms daily
