Heart Failure Flashcards

1
Q

Define Heart Failure

A

Heart failure is defined as a condition where there is an abnormality of the structure and function of the heart to deliver oxygen to meet the metabolic demands of metabolizing tissue despite normal filling pressures.

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2
Q

Describe the two types of dysfunction associated with heart failure and compare what occurs here with normal heart function

A

Normal function: ventricles fill with blood and pump out 60% of blood
Systolic dysfunction: the enlarged ventricles fill with blood but pump out between 40 -50% of the blood from the ventricles.
Diastolic dysfunction: the ventricles are stiff, and as a result fill with less blood. They still pump out 60% of however much blood fills the ventricles

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3
Q

What is the Frank-Starling Law?

A

Cardiac Output= Heart Rate * Stroke Volume

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4
Q

What is Left Ventricular Systolic Dysfunction?

A

This is heart failure with a reduced ejection fraction

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5
Q

Which of these is not associated with heart failure?

a. Dyspnoea
b. Fatigue
c. Bradypnoea
d. Peripheral oedema
e. Orthopnoea

A

c. Bradypnoea - Bradypnoea is defined as having fewer breaths per minute, a heart failure would have more breaths per minute.

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6
Q

Which of these is not associated with heart failure?

a. Elevated venous jugular pressure
b. Paroxysmal nocturnal dyspnoea
c. Increased exercise tolerance
d. Irregular pulse

A

c. Increased exercise tolerance - should be decreased exercise tolerance

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7
Q

What are the 4 classes associated with the New York Heart Association (NYHA) classification of
symptoms of heart failure and the symptoms associated with each class?

A

Class 1- No limitations with ordinary physical activity
Class 2- Slight limitation with dyspnoea on moderate to severe exertion
Class 3- Marked limitation- less than severe activity causes dyspnoea
Class 4- Severe disability dyspnoea at rest

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8
Q

7 common causes of heart failure include:

A
  • Coronary artery disease
  • Valvular disease
  • Arrhythmia
  • Cardiomyopathy (familial or acquired)
  • Congenital heart disease
  • Non-cardiac causes e.g. anaemia, pregnancy
  • Hypertension
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9
Q

Name 4 ways in which heart failure can be diagnosed

A

Chest X-Ray
Echocardiogram
Electrocardiogram
NT-proBNP

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10
Q

List 5 goals of heart failure treatment

A
Relieve or reduce symptoms
Prevent hospital admission
Improve quality of life
Improve survival
Slow disease progression
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11
Q

Treatment algorithm for Heart Failure:

A

ACE/ARB
B-blocker
Spironalactone

Add diuretics for symptomatic relief
Add digoxin in AF and symptomatic with 1st/2nd line
Add Ivabradine in SR and when HR >75 bpm and
symptomatic with 1st/2nd line

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12
Q

Which diuretics are preferred more for symptomatic relief: loop or thiazide and why?

A

Loop because they produce a more intense and shorter diuresis

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13
Q

Name the 4 types of diuretics and how they act

A

Carbonic anhydrase inhibitors - these inhibitors inhibit carbonic anhydrase (CA) situated in the PCT- less H+ is generated so less Na+ exchanged with H+ from the Na+/H+ exchanger so more Na+ in the nephron -> more excreted

Loop Diuretic - Loop diuretics work by inhibiting a Na+/K+/Cl- cotransporter found in the thick ascending limb of the loop of Henle

Thiazide Diuretic - Inhibits a Na+/CL- transporter in the DCT

Aldosterone Antagonist - Inhibits Na+ reabsorption by inhibiting aldosterone binding to the collecting duct and some parts of the DCT

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14
Q

Name three instances where ACEi are contraindicated

A

Angiodema, bilateral renal artery stenosis and chronic aortic stenosis

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15
Q

What are side effects associated with B-blockers?

a. Bradycardia
b. Fatigue
c. Peripheral vasoconstriction
d. Erectile dysfunction
e. Bronchospasm
f. All of them

A

I think all of them

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16
Q

Name two new drugs used in heart failure

A

Sacubitril/Valsartan (ERNESTO)

Angiotensin-neprilysin inhibitor