Heart Failure Flashcards
What is congestive heart failure?
When the heart is unable to pump blood at a rate that meets the requirements of the tissue or can do so only from high pressures
What are underlying structural abnormalities which can cause heart failure?
LV systolic dysfunction Valvular heart disease Pericardial constriction or effusion LV diastolic dysfunction/HF with sys function or normal EF Tachycardia or bradycardia MI Restrictive cardiomyopathy (amyloid, hypertrophic CM) RV failure: primary or secondary PHT
What are the causes of LVSD?
Ischaemic heart disease (MI) Severe AV disease or MR Dilated cardiomyopathy Hypertension HIV, lyme's disease
What are the symptoms of congestive heart failure?
Dyspnoea
Fatigue
Oedema
Reduced exercise capacity
What are the signs of CHF?
Oedema Tachycardia Raised JVP Chest crepitation or effusion 3rd heart sound Displaced apex beat
Why carry out an CXR?
Signs of: Pul. oedema Cardiomegaly Effusion Sternal wires (previous op)
What bloods should be carried out?
FBC Fasting glucose U+Es Urinalysis TFT
What investigations should be carried out?
CXR Bloods Echo Radionucleotide scan L ventriculogram (angiogram) CMRI ECG (HF unlikely is normal) BNP level - Amino acid peptide elevated in HF Response to therapy (diuretics) MUGA scan for LVEF
What tests are used to show evidence of cardiac dysfunction?
Echo
Radionecleotide scan
L ventriculogram (angiogram)
CMRI
Name types of diuretic drugs
Furosemide and bumetanide
Name types of ACEi drugs
Ramipril, enalpril snd lisinopril
What are the ranges of LV ejection fraction?
Effected by disease - anaemia, sepsis etc Normal: 50-80% Mild: 40-50% Moderate: 30-40% Severe: <30%
How does heart failure affect cardiac output?
HF does not mean reduced CO - EF might lower but might be tachcardic to compensate
Is heart failure the final diagnosis?
No, there is underlying structural abnormality and cause:
HF due to LVSD due to IHD
HF due to severe aortic stenosis
What percentage of people in the UK suffer from HF?
1-2%
What is the prognosis in the first year of developing HF?
Poor: 30-40% mortality
How many inpatient bed days are caused by HF and what is the readmission rate over the nest 3 months?
1 million inpatient bed days
50% readmitted
What are the factors that are contributing to the increase in prevalence of heart failure?
Treatment of acute myocardial infarction - prev MI increases risk of CHF
Ageing population
Increased prevalence of: hypertension, CHD, obesity, diabetes, high cholesterol
What does displaced apex beat indicate?
Enlargement of the heart
What is the 2/3 criteria for heart failure to be diagnosed?
- Symptoms or signs of HF (rest or exercise)
and - Objective evidence of cardiac dysfunction
and (in doubtful cases) - Response to therapy (diuretics)
What are the 2 investigations that can be carried out for screening for congestive heart failure?
ECG - if normal then rules out LVSD
Brain natriuretic peptide - the amino acid is elevated in HF, low BNP excludes HF
What does raised brain natiuretic peptide indicate?
Heart failure or left ventricular systolic dysfunction, and indicates the need for echo/cardiac assessment
What is the order of investigations and examination for the diagnosis of HF?
- Symptoms of signs suggest CHF
- FBC, fasting blood glucose, U+Es, urinalysis, TFT and CXR
- BNP and ECG
- If BNP elevated or ECG abnormal
- Refer for echocardiography
What is way to diagnose LVSD?
- Clinical history: MI, DM, HBP, post partum, alcohol
- ECG, CXR, and always an echo
- Coronary angigraphy (if chest pain, <70)
- Cardiac MRI: infarction/inflammation/fibrosis
