Heart failure Flashcards
(20 cards)
What is HF
Left ventricular ejection fraction
What percentage is reduced ejection fraction
<40
Ventricles lose ability to contract normally
What percentenatge is preserved ejection fraction
> 50%
Ventricles losses ability to relax normally
Can HF be diagnosed if there are symptoms of HF but ejection fraction is preserved
Yes
Signs and clinical features of HF
• pitting Odema
• SOB
• orthopnoea
• tachycardia
• third heart sound
• increased jugular pressure
• pulmonary odema
Test diagnosis
ProBNP (high levels in HF)
ECG
CXR
Echo
Which levels of ProBNP makes HF likely
> 400
Management of HF with reduced ejection fraction?
Step 1
Loop diuretics for symptoms of fluid overload
Furosemide
Management of HF with reduced ejection fraction?
Step 2
ACE or ARB + BB
BB licenced in HF - bisoprolol, carvedidol, nebivovol
Management of HF with reduced ejection fraction?
Step 3
Mineralcorticoid receptor antagonist
Spiractolone
Eplerenone
What if patients are intolerant to ARBs or ACEi
Hydralazine + nitrate
Now despite optimal standardized care
What to do if patient with sinus rhythm have heart rate over 75
Ivabradine
Now despite optimal standardized care
What is patients ejection fraction is <35
Replace ACEI with sacubitril valsartan
Now despite optimal standardized care
Patients with sinus rythm to improve symptoms?
Digoxin
Now despite optimal standardized care
+ SGLT2 inhibitor
What can you give in preserved ejection fraction HF
Medium dose loop diuretic
SGLT2 inhibitors
Which main class of drugs should be avoided in HF
Rate limiting CCB - verapamil, diltiazam
Short acting dihydropyradine CCB - nifedipine
These reduce cardiac contracility
Which vaccinations are recommend
Pneumococcal
Influenza
Why rate limiting and what does it interact with
In interacts with BB - causes bradycardia
Why should rate limiting dihydropyradines be avoided
They’re are negative iontropes further reducing effected contraction in HF
