Week 238 - Heart Failure Flashcards
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.
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.
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.
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.
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.
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.
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
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
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
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.
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.
Week 238 - Heart Failure: How do people with acute heart failure usually present?
• Pulmonary oedema, cardiogenic shock or increasing dyspnoea.
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.
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
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.
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)
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.
Week 238 - Heart Failure: How do thiazides work?
• Act at the beginning of the distal convoluted tubule to inhibit Na+ reabsorption.
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.
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.
Week 238 - Heart Failure: Give some examples of thiazide diuretics.
- Bendroflumethiazide
- Chlortalidone
- Hydrochlorothiazide
- Metolazone
- Indapamide
Week 238 - Heart Failure: What role do opiates play in the treatment of acute heart failure?
- Relieve anxiety and distress due to dyspnoea.
* Venodilators
Week 238 - Heart Failure: How do vasodilators help in heart-failure?
Reduce preload, afterload and increases stroke volume.
Week 238 - Heart Failure: Nitroglycerine is a vasodilator used in treatment of heart-failure, however it does not relieve dyspnoea. Which vasodilator does?
Nesiritide.
