heart failure Flashcards

Question

how does left ventricular failure effect the lungs

Answer 1

Pressure in the pulmonary veins is transmitted to the capillaries and arteries This leads to pulmonary congestion and oedema

Answer 2

Breathlessness (dyspnoea) exaggeration of breathlessness that follows exertion Orthopnoea – breathlessness lying flat that is relieved by sitting or standing Paroxysmal nocturnal dyspnoea – an extension of orthopnoea with attacks of extreme dyspnoea bordering on suffocation usually occuring at night

Answer 3

Decreased cardiac output Reduction in renal perfusion Activation of renin - angiotensin – aldosterone system Retention of salt and water with expansion of interstitial fluid and blood volumes

Answer 4

``` Hypoxic encephalopathy Irritability Loss of attention Restlessness Stupor and coma ```

Answer 5

Usually consequence of left sided HF (congestive cardiac failure (CCF))

Answer 6

Right sided HF due to significant pulmonary hypertension due to increased resistance within the pulmonary circulation Usually as a result of respiratory disease e.g. COPD or pulmonary emboli

Answer 7

Valvular heart disease | Congenital heart disease

Answer 8

``` Liver and portal system Congestive hepatomegaly, Centrilobular necrosis when severe, Cardiac cirrhosis Spleen Congestive splenomegaly Abdomen Ascites Subcutaneous tissue Peripheral oedema pretibial oedema Sacral oedema if bedridden Pleural and pericardial space effusions ```

Answer 9

same pathological process on each side of the heart or consequence of left heart failure leading to vol overload of the pulmonary circulation and eventually the right ventricle causing right ventricular failure

Answer 10

``` Due to excess fluid accumulation Dyspnoea Orthopnoea, paroxysmal nocturnal dyspnoea Oedema Hepatic congestion Ascites Due to reduction in cardiac output Fatigue Weakness ```

Answer 11

Class I: No limitation of physical activity Class II: Slight limitation of ordinary activity Class III: Marked limitation, even during less-than-ordinary activity Class IV: Severe limitation with symptoms at rest

Answer 12

``` Cool, pale, cyanotic extremities Tachycardia Elevated JVP Third heart sound (S3) – gallop rhythm Displaced apex (LV enlargement) Crackles or decreased breath sounds at bases on chest auscultation Peripheral oedema Ascites Hepatomegaly ```

Answer 13

``` CXR ECG Blood investigations Echocardiogram / Cardiac MRI or CT / CT-PET CTCA / Coronary angiography ```

Answer 14

``` detailed history and clinical exam measure NT-proBNP ECG (CXR, BT, PF, urinalysis) may have specialist assessment assess severity, establish cause and correctable causes ```

Answer 15

diuretics for congestive symptoms and fluid retention preserved ejection fraction - manage cormorbidities reduced ejection fraction - ACE I or BB all personalised exercise based cardiac rehab programme specialist re assessment

Answer 16

FRUSEMIDE, BUMETANIDE Inhibit Na+ re-absorption from the proximal tubule K+ loss from distal tubule

Answer 17

Can be given iv or orally can- electrolyte abnormalities hypovolaemia and diminished renal perfusion

Answer 18

EPLERENONE, SPIRONOLACTONE Acts on distal tubule Promotes Na+ excretion and K+ re-absorption Reduces hypertrophy and fibrosis

Answer 19

Gynaecomastia (esp. Spironolactone) | Electrolyte (K+ high) and renal function abnormalities

Answer 20

RAMIPRIL, PERINDOPRIL, ENALAPRIL, CAPTOPRIL, LISINOPRIL Act on activated renin - angiotensin system Given orally in small doses with slow titration Block production of angiotensin: Vasodilatation BP lowering Reduce cardiac work

Answer 21

cough, hypotension, renal impairment

Answer 22

BISOPROLOL, CARVEDILOL, METOPROLOL Block the action of adrenaline and noradrenaline on adrenergic beta receptors Slow HR, reduce BP Given orally in small doses with slow titration (treat arrhythmias)

Answer 23

Bronchospasm | Claudication

Answer 24

IVABRADINE Blocks the If channel within the SA node Slow HR, no effect on BP Given orally with dose titration

Answer 25

Visual aura | Bradycardia

Answer 26

Increases myocardial contractility Slows conduction at the AV node (use in AF) Excreted by kidney - Toxicity important

Answer 27

Acute HF especially in AF | Chronic HF in selected cases

Answer 28

SACUBITRIL VALSARTAN Acts on activated renin - angiotensin system blocks breakdown of ANP/BNP Block production of angiotensin: Vasodilatation, BP lowering, reduce cardiac work Promote natriuresis Sodium excretion, vasodilatation, reduce hypertrophy and fibrosis

Answer 29

hypotension, renal impairment

Answer 30

``` Cardiac Resynchronisation Therapy (CRT) Implantable Cardioverter Defibrillator (ICD) Dialysis & Ultrafiltration Ventricular Assist Device (LVAD/RVAD) Intra-aortic balloon pump Cardiac transplantation (Stem cell therapy) ```

Answer 31

Standard pacemakers equipped with two wires (or "leads") conduct pacing signals to specific regions of heart. Biventricular pacemakers have an third lead to conduct signals directly into the left ventricle.

Answer 32

Combination of all three leads promote synchronised pumping of ventricles, increasing efficiency of each beat and pumping more blood on the whole.