Heart failure Flashcards
What are the causes of heart failure?
Myocardial -IHD; cardiomyopathy; cor pulmonale; valve disease; htn Valvular Pericaridal Arrhythmias High output states (anaemia, high thyroid, Paget’s) Volume overload (CKD) Obesity Drugs (alcohol)
What is the difference between right and left heart failure?
Right HF: RV fails so means back up of blood to the bpdy and lack of blood to lungs: see raised JVP; oedema
Left HF: LV failure means blood backs up into lungs and less blood leaves to go to body: crackles, dyspnoea; less perfusion; fatigue
How does the body attempt to compensate for HF?
HF compensatory - wants it to beat more - sympathetic NS; heart beats faster (increased HR and SV) plus RAAS increases
Increased venous return (preload) and decreased outflow resistance (afterload)
What is the difference between preserved and reduced ejection fraction HF?
Reduced EF - defined as heart failure with an ejection fraction less than 40% on an echo
What are the 3 cardinal sx of HF?
breathlessness (worse when lie down), fluid retention, and fatigue
What are the other sx of HF?
nocturnal cough up pink frothy sputum; orthoponea; PND; syncope; dyspnoea;
What are the signs of HF?
tachycardia, tachypnoea, basal creps, oedema, obesity, Cardiomegaly murmurs: 3rd (causes a gallop rhythm) and 4th heart sounds added displaced apex (LV dilation), RV heave (pulmonary hypertension) raised JVP, hepatomegaly, ascites, pleural effusion
What ix should be done for HF?
- Has the patient had a previous MI?
- Yes -> Urgent Transthoracic Echo (TTE)
- No -> measure serum BNP
> Above 4000pg/ml -> urgent TTE
> 100 - 4000pg/ml -> TTE within 6 weeks
Other tests that can be helpful:
ECG - to consider aggrevating factors
CXR
Blood tests: FBC, U&E and eGFR, LFTs, HbA1c, lipids, TFTs; consider cardiac enzymes if an undiagnosed MI is possible in the preceding few days.
What may be seen on a CXR with HF?
ABCDEH
Alveolar shadowing (bat wings)
Kerley B lines
Cardiomegaly (cardiothoracic ratio >50%).
Dilated veins
Pleural Effusions. (costophrenic angle blurred)
Ventricular Hypertrophy.
Describe the New York Associations classification system
Class I: no symptoms on ordinary physical activity.
Class II: slight limitation of physical activity by symptoms.
Class III: less than ordinary activity leads to symptoms.
Class IV: inability to carry out any activity without symptoms.
What drugs do you give to a pt with reduced ejection fraction vs preserved?
diuretic, ACE inhibitor and beta-blocker in reduced
–> only do dieuretic in preserved EF (furosemide)
What general management should be considered in all pts with HF?
Prescribing an antiplatelet drug and statin
Comorbidities and precipitating factors should be managed.
Screening for depression or anxiety
A cardiac rehabilitation programme should be offered.
Appropriate vaccinations should be offered.
What diuretic is first line and how does it work?
furosemide 1st line - acts on loop of henle + dilate veins to reduce preload - dont want pt to lose more than 1kg/ day wt loss due to water loss. MONITOR renal function
What ACE-i is first line in HF and how does it work?
ACE-i eg ramipril - block ACE enzyme in REN system → reduced aldosterone promotes water and sodium secretion - reduced preload (NEED to monitor kidney function)
What beta blocker is first line and how doe they work?
Beta blocker eg bisoprolol and atenolol - improves prognosis - works mostly on beta 1 receptors which reduces force and speed of heart contraction - protects heart from chronic sympathetic stimulation - aim for 55-60 BPM
