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
List some causes of HF
Valvular heart disease
Hypertension heart disease
Congenital heart disease
What is the mechanism of orthopnoea?
Shift of blood volume into the central circulation causes increased pulmonary capillary pressure > more oedema
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
What are the long term effects of increase sympathetic NS activation in HF?
Direct toxic affects of adrenaline/noradrenaline
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
At what venous pressure will oedema occur?
What are some non-pharmacological intervention in HF?
Cardiac synchronisation with biventricular pacemaker
Implantable cardiac defibrillator
Fluid and Na restriction
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
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
How do you management an acute exascerbation of HF?
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
Which beta-blockers are used in HF?
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