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Flashcards in Week 238 - Heart Failure Deck (49):
1

Week 238 - Heart Failure: What are the CXR signs of heart failure?

• Caridomegaly
• Upper zone vessel enlargement - A sign of pulmonary venous hypertension.
• Pulmonary oedema - Bat-wing shape of increased lung-markings.
• Kerley B lines.
• Pleural effusions.

2

Week 238 - Heart Failure: What are Kerley B lines?

• These are specific radiographic signs of pulmonary oedema.
• Small horizontal lines along the lateral borders of the lung fields.

3

Week 238 - Heart Failure: What is the management of renal deterioration?

• Stop furosemide.
• Decrease statins.
• Commence isosorbide mononitrate and later hydralazine which are both vasodilators.

4

Week 238 - Heart Failure: When someone has features of both left and right sided heart failure they are said to have what?

Congestive cardiac failure.

5

Week 238 - Heart Failure: What is the presentation of Right sided heart failure?

• Oedema and ascites.
• Liver congestion - Impaired liver function.
• GI tract congestion - Anorexia, GI distress, Weight loss.

6

Week 238 - Heart Failure: What is the presentation of Left heart failure?

• Decreased cardiac output - Activity intolerance, Cyanosis, signs of hypoxia.
• Pulmonary congestion - Othropnoea, Cough with frothy sputum, Paroxysmal nocturnal dyspnoea.

7

Week 238 - Heart Failure: What are the SIGNS of right-sided heart failure?

• Anorexia
• Increased JVP
• Ascites
• GI distress
• Sacral oedema
• Dependent oedema
• Hepato/splenomegaly
• Fatigue

8

Week 238 - Heart Failure: What are the SIGNS of left-sided heart failure?

• Coughs, Crackles, Wheeze, PND, Orthopnoea, Tachypnoea
• Cyanosis and hypocia
• Frothy white sputum
• Exertional dyspnoea

9

Week 238 - Heart Failure: What is the difference between systolic and diastolic heart failure?

Both are left-sided!
• Systolic - Insufficient contraction (E.g. post-MI)
• Diastolic - Insufficient relaxation

10

Week 238 - Heart Failure: What is the NYHA classification of heart failure?

• Class 1 - Cardiac disease, but ordinary exercise does not cause undue fatigue, palpitation, dyspnoea or anginal pain.

• Class 2 - Cardiac disease with a slight limitation on exercise but are comfortable at rest.

• Class 3 - Cardiac disease with marked limitation on exercise but are comfortable at rest.

• Class 4 - Cardiac disease with inability to carry out any physical activity without discomfort. Symptoms may be present at rest.

11

Week 238 - Heart Failure: What is the definition of acute heart failure?

A rapid change in the onset or change in symptom and signs of heart failure - Life-threatening.
- Often see in decompensation of a patient with chronic HF.

12

Week 238 - Heart Failure: How do people with acute heart failure usually present?

• Pulmonary oedema, cardiogenic shock or increasing dyspnoea.

13

Week 238 - Heart Failure: What is the general management of someone with acute heart failure?

• Admission to monitored area.
• Key drugs: Oxygen, diuretics and vasodilators.
• Non-invasive ventilation may be needed.
• Monitor: HR + rhythm, BP, Sats, urine output.

14

Week 238 - Heart Failure: In which situation should oxygen be administered in acute heart failure? What is the problem with using inappropriately?

• Use if Sp02

15

Week 238 - Heart Failure: What is the specific management of acute left ventricular failure?

• Oxygen
• Diamorphine 2.5mg IV
• Metoclopramide 10 mg, IV
• Furosemide 40-80mg, IV
• IV nitrates
• Consider non-invasive/mechanical ventilation.

16

Week 238 - Heart Failure: In the case of an acute on chronic heart failure situation, what diuretic may need to be added to furosemide?

Metolazone (thiazide-like)

17

Week 238 - Heart Failure: Which type of diuretic is ideal for the use with acute and chronic heart failure? Why?

Loop-diuretics - Furosemide.
• More potent diuresis and act quicker and last for a shorter time than thiazides.

18

Week 238 - Heart Failure: How do thiazides work?

• Act at the beginning of the distal convoluted tubule to inhibit Na+ reabsorption.

19

Week 238 - Heart Failure: How do loop diuretics work?

As it says on the tin, they act on the loop of Henle by inhibiting Na+ reabsorption.

20

Week 238 - Heart Failure: What are the side-effects of thiazide (and related) diuretics?

• Electrolyte disturbance - reduced Na+ and K+
• Increased risk of gout due to increased urate.
• Hyperglycaemia.
• Deranged lipids.

21

Week 238 - Heart Failure: Give some examples of thiazide diuretics.

• Bendroflumethiazide
• Chlortalidone
• Hydrochlorothiazide
• Metolazone
• Indapamide

22

Week 238 - Heart Failure: What role do opiates play in the treatment of acute heart failure?

• Relieve anxiety and distress due to dyspnoea.
• Venodilators

23

Week 238 - Heart Failure: How do vasodilators help in heart-failure?

Reduce preload, afterload and increases stroke volume.

24

Week 238 - Heart Failure: Nitroglycerine is a vasodilator used in treatment of heart-failure, however it does not relieve dyspnoea. Which vasodilator does?

Nesiritide.

25

Week 238 - Heart Failure: Once acute heart failure has been stabilised what is the medication used?

ACE-inhibitor
Beta blocker

26

Week 238 - Heart Failure: In NYHA class II-IV which three drug classes are strongly recommended for therapeutic use?

• ACE-I
• Beta blocker
• Mineralocorticoid receptor antagonist

27

Week 238 - Heart Failure: In which patients are ACE-I indicated for?

All those with a left-ventricular ejection fraction of

28

Week 238 - Heart Failure: How do ACE-I improve pre-load and after load?

• ACE-I reduce the breakdown of Bradykinin. (along with effect of ATII)
• Bradykinin is an inflammatory mediator which leads to vasodilation.
• This vasodilation is why pre-load and after-load are reduced.

29

Week 238 - Heart Failure: Which ACE-I is still frequently used in paediatric cardiology?

Captopril

30

Week 238 - Heart Failure: What are the contraindications for use of an ACE-I?

• Severe aortic stenosis, mitral stenosis, Left-ventricular outflow obstruction
• Bilateral renal artery stenosis
• Pregnancy
• History of idiopathic/hereditary angioedema
• Creatine >220umol/l

31

Week 238 - Heart Failure: Give examples of some Angiotensin II receptor antagonists.

• Candesartan
• Valsartan
• Erpotsartan
• Losartan

32

Week 238 - Heart Failure: What should be used instead of ACEI/ARBs if they are not tolerated?

Isosobide dinitrate and hydralazine.
(Along with Beta-blocker,digoxin,aldosterone antagonist)
(If still symptomatic)

33

Week 238 - Heart Failure: What is the role of aldosterone antagonism in treatment of heart failure?

• Added to conventional therapies in order to suppress aldosterone levels - cardioprotective.

34

Week 238 - Heart Failure: In which patients are aldosterone antagonists indicated?

• Severe symptomatic heart failure (grade III/IV) with LVEF

35

Week 238 - Heart Failure: What do alpha-receptor agonists do? (Vascular)

• Constrict vessels
- Increases Total peripheral resistance
- Increases central venous pressure > Decreases cardiac output

36

Week 238 - Heart Failure: What are the main contraindications of beta-blockers?

• Asthma / COPD
• Cardiac conduction defects.
• Severe heart failure
• Severe peripheral vascular disease
• Raynaud's disease

37

Week 238 - Heart Failure: Which beta-blockers have specifically been show to be helpful in heart failure?

• Bisoprolol
• Carvedilol
• Metoprolol
• Nebivilol

38

Week 238 - Heart Failure: Which beta-blocker is used in pregnancy and is used as an IV infusion for the rapid control of BP?

• Labetolol

39

Week 238 - Heart Failure: What is Ivabradine?

It inhibits the If(funny) channel in the sinus node, thereby slowing the heart rate in sinus rhythm.
- Has been shown to reduce hospitalisation in HF patients.

40

Week 238 - Heart Failure: Why do you get oedema in heart failure?

Increases in venous pressure and GFR causes salt and water retention.

41

Week 238 - Heart Failure: What are the common causes of heart failure?

• IHD
• Hypertension
• Valvular heart disease
• Cardiomyopathy
• Toxic - alcohol
• Diabetes

42

Week 238 - Heart Failure: What are the main causes of right heart failure?

• Chronic lung disease
• Pulmonary hypertension
• Left to right intra cardiac shunts
• Chronic valvular heart disease

43

Week 238 - Heart Failure: What is cardiac cachexia?

Weight loss and anorexia commonly seen in heart failure.
- Due to metabolic changes, gut congestion, reduced intake and inflammatory causes.

44

Week 238 - Heart Failure: Which of the types of left-sided heart failure has a normal ejection fraction?

Diastolic

45

Week 238 - Heart Failure: What are the differential diagnoses for high output heart failure?

• Anaemia
• Septicaemia
• Liver-failure
• Beri-beri
• Thyrotoxicosis
• Paget's disease
• AV shunt

46

Week 238 - Heart Failure: The increase of which substances in the blood may indicate myocardial wall stress?

• B-type natriuretic peptide (BNP)
• N-terminal pro-BNP

47

Week 238 - Heart Failure: What may you see on an echocardiogram that would suggest heart failure?

• Dilated LV/RV
• Reduced LV/RD contractility
• Valve lesions

48

Week 238 - Heart Failure: What are the surgical options for treatment of heart failure?

Depends on the underlying cause.
- Revascularisation - CABG and PCI
- Treatment of valvular heart disease

49

Week 238 - Heart Failure: What changes occur during auscultation of the heart in heart failure?

Third heart sound - gallop rhythm