Heart Failure Flashcards Preview

Hugh's MD2 Core Conditions and Presentations > Heart Failure > Flashcards

Flashcards in Heart Failure Deck (13):
1

Outline the New York Heart Association's classification of heart failure

I - No limitation of physical activity. Systolic dysfunction on echo

II - Slight limitation of physical activity. No distress at rest

III - Significant limitation of physical activity. No distress at rest

IV - Unability to carry out physical activity without distress. Symptoms at rest

2

List some causes of HF

IHD

Valvular heart disease

Hypertension heart disease

Congenital heart disease

Cardiomyopathy

Cor pulmonale

Pericardial disease

3

What is the mechanism of orthopnoea?

Shift of blood volume into the central circulation causes increased pulmonary capillary pressure > more oedema

4

Outline the principles of long term management of HF?

Reduce venous pressure (without significantly reducing CO)

Block the renin-angiotension system

Block sympathetic NS stimulation

Treat underlying and precipitating causes

5

What are the long term effects of increase sympathetic NS activation in HF?

Vasoconstriction

Ventricular arrhythmias

Direct toxic affects of adrenaline/noradrenaline

6

Describe the mechanism of the spiral of fluid retention that can occur in HF

Decreased CO > Decrease renal perfusion > Activation of RAAS > Increase fluid and Na retention, K loss

7

At what venous pressure will oedema occur?

>20-30mmHg

8

What are some non-pharmacological intervention in HF?

Cardiac synchronisation with biventricular pacemaker

Implantable cardiac defibrillator

Transplant

Fluid and Na restriction

Light exercise

Smoking cessation

9

Which drug classes are core for the treatment of HF and when is each used (NYHA classification)?

ACEi - NYHA 1-4

B-blockers - NYHA 2-4

Ivabradine - NYHA 2-4 (funny channel blocker in SA node to reduce HR)

Spirolactone - NYHA 3-4

 

Loop diuretics for symptomatic relief

10

What is the role of calcium channel blockers in HF?

Non-dihydropyridines are not indicated as they provide not protection against pathological remodelling

 

Dihydropyridines are used for treatment of HTN and angina, they have no long term benefit otherwise

11

How do you management an acute exascerbation of HF?

Admit

Resus, fluid and Na restriction

Diuresis to achieve fluid balance with loop diuretics

GTN to dilate coronaries and reduce preload

Morphine for anxiolytic effect

Inotrophic drugs - Digoxin

12

Which beta-blockers are used in HF?

Metoprolol

Bisoprolol

Carvedilol

 

13

How does treatment of diastolic HF differ from systolic?

ACEi, Beta-blockers, and ARBs demonstrate no mortality benefit

Mainstay of treatment is control of risk factors