Heart Failure Flashcards
(32 cards)
Heart Failure
CO is inadequate for the body’s requirements.
two types of HF:
low output and high output HF
- definition of each
- causes of each?
Low output = CO is down and fails to increase normally with exertion.
High output = Rare.
CO is normal or increased due to increased demand.
Failure occurs when CO fails to meet these needs.
Causes:
High output HF:
1) Anaemia
2) Pregnancy
3) Hyperthyroidism
Low output HF:
- mitral regurgitation (LV dilatation)
- aortic stenosis (LV thickening)
- HTN
high output HF - features of Left HF or Right HF?
Intially features of RHF then LVF becomes evident later.
SYSTOLIC FAILURE
ejection fraction?
heart abnormality?
Causes?
- Inability of the ventricle to contract normally, resulting in reduced CO.
- Ejection fraction is <40%.
- Dilated heart
= MI, IHD, cardiomyopathy
DIASTOLIC FAILURE
ejection fraction?
heart abnormality?
causes?
- Inability of the ventricle to relax and fill normally, causing increasing filling pressures, typically Ejection fraction >50%.
- Hypertrophied heart.
- Typically HF with preserved EF.
ventricular hypertrophy, constrictive pericarditis, tamponade
bilateral or unilateral leg swelling ?
Bilateral leg swelling (suggests cardiac failure) whereas unilateral swelling suggest venous disease and trauma.
LV FAILURE:
features?
CXR - FOR LV failure?
ABCDE
- dyspnoea
- orthopnoea
- PND
- pulmonary oedema
- nocturnal cough (+/- pink sputum)
A – alveolar oedema ‘bat’s wings’ B – kerley b lines C – cardiomegaly D – dilated upper lobe vessels E – pleural effusion
RV FAILURE:
features?
- peripheral oedema (upto thighs)
- ascites
- anorexia
- epistaxis
- facial engorgement
- raised JVP
LVF and RVF may occur independently or together as ?
CCF (congestive cardiac failure)
long term LVF leading to RVF
what is the criteria for CCF?
Framingham criteria
presence of 2 major or 1 minor criteria
Refer someone with suspected HF for a transthoracic Doppler 2D echo within?
why do you do echo?
2 weeks
TO determine if there is LV dysfunction
chronic HF
- ECG changes?
bloods: - BNP - when is it released?
- if BNP >100?
- if BNP <100?
- BNP and ECG normal?
- LVH, Q waves
BNP is secreted from ventricular myocardium and is released in LV dysfunction
– diagnoses HF better than any other clinical marker.
- exclude HF or LV failure
If ECG and BNP are normal = HF is highly unlikely.
classification of HF?
NEW YORK CLASSIFICATION OF HF
- Grade I = heart disease present but no dyspnoea.
- Grade II = comfy at rest and dyspnoea during activity.
- Grade III = ordinary activity causes dyspnoea, limiting,
- Grade IV = dyspnoea at rest.
CHRONIC HF - Mx
1st line?
2nd line?
3rd line?
1st line = ACE-i + b-blocker + furosemide
2nd line = spironolactone + valsartan + hydralazine/isosorbide mononitrate
3rd line = Digoxin = cardiac glycoside that increases myocardial contraction and reduces conductivity in AV node – helps symptoms even in those with sinus rhythm.
acute HF - usually LV OR RV?
Usually LV failure,
Signs of Acute HF?
characteristic sign of Acute HF: pulsus alterans - what is it?
- indicative of what impairment?
- Dyspnoea
- Orthopnoea
- Pink frothy sputum
- Distressed, pale, sweaty,
- Lung crackles
Resulting in severe pulmonary oedema.
pulsus alterans = alternating between strong and weak beats
LV systolic impairment
Acute HF - Mx
high flow oxygen
Diamorphine IV
Furosemide IV
GTN spray
if systolic BP >100 : give isosorbide dinitrate
A 78-year-old man is recovering after an ST elevation myocardial infarction (STEMI). In the past hour, his pulse rate has increased from 100 to 130bpm and his respiratory rate from 20 to 30/min. The junior doctor is called. The patient has a productive cough and is sitting forward with his hands on his knees. Which single treatment is most likely to reverse this man’s deterioration?
Bendroflumethiazide 2.5 mg PO Bumetanide 1 mg PO Furosemide 80 mg IV Heparin 5000U IV Metoprolol 50 mg IV
Furosemide 80 mg IV
This man is displaying the signs of severe acute heart failure, common after an MI, and requires intravenous diuresis
A 36-year-old woman has been lethargic and felt increasingly dizzy over the last 2 months. She is usually well but does report long and very heavy periods, especially in the last 6 months.
T 36.6°C, HR 110bpm, BP 95/65mmHg.
Her JVP is visible 5cm above the sternal angle and she has bilateral ankle oedema pitting to the mid-calf. In her chest there are fine end-inspiratory crepitations heard at both bases. Which is the single most appropriate next step?
Furosemide 40mg IV Human albumin solution 20% 200 mL IV Iron sucrose 200 mg IV Packed red cells 2U IV Vitamin K 10 mg IV
Packed red cells 2U IV
This is symptomatic anaemia (Hb usually <50g/L) causing heart failure. In treating the low Hb, it is important to transfuse slowly in conjunction with a diuretic, e.g. furosemide 10–40mg IV with alternate units.
A 78-year old woman is admitted with heart failure. The underlying cause is determined to be aortic stenosis. Which sign is most likely to be present?
Pleural effusion on CXR Raised JVP Bilateral pedal oedema Bibasal crepitation Atrial fibrillation
Bibasal crepitation
A 78-year old woman is admitted to your ward following a 3-day history of shortness of breath and a productive cough of white frothy sputum. On auscultation of the lungs, you hear bilateral basal coarse inspiratory crackles. You suspect that the patient is in congestive heart failure. You request a CXR. Which of the following signs is not typically seen on CXR in patients with congestive cardiac failure?
Lower lobe diversion Cardiomegaly Pleural effusions Alveolar oedema Kerley B lines
Lower lobe diversion
A patient with known heart failure is unable to carry out any physical activity without discomfort. Symptoms of heart failure are present even at rest with increased discomfort with any physical activity. What New York Heart Association class best describes the severity of their disease?
NYHA Class I
NYHA Class II
NYHA Class III
NYHA Class IV
NYHA Class IV
An 82-year-old lady is found to have heart failure with a left ventricular ejection fraction (LVEF) of 30%. Her renal function is normal and BP is 165/102mmHg. She is not taking any other medication. What combination of drugs would be the best initial treatment for her?
Amlodipine + Spironolactone
Bisoprolol + Lercanidipine
Furosemide + digoxin
Ramipril + Bisoprolol
Ramipril + Bisoprolol
Patients with heart failure with reduced LVEF should be given a beta blocker and an ACE inhibitor as first-line treatment
Should be offered annually for all patients with heart failure
A. Pneumococcal vaccine B. Influenza vaccine C. Calcium channel blocker D. Spironolactone E. ACE inhibitor + beta-blocker F. Hydralazine + nitrates G. ACE inhibitor + frusemide H. Digoxin I. Echocardiogram J. Electrocardiogram
Influenza vaccine
