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10 Cards in this Set
- Front
- Back
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New York Heart Association functional classification of heart failure
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I - cardiac disease, but no symptoms, no limitation on ordinary physical activity
II - mild symptoms and slight limitation during ordinary activity III - marked limitation in activity due to symptoms, even during less-than-ordinary activity. comfortable only at rest IV - severe limitations, symptoms even at rest, mostly bed bound |
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diagnostic factors
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-presence of risk factors
-dyspnoea -neck vein distenstion -S3 gallop -cardiomegaly -crepitations -oedema |
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risk factors for heart failure
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-history of MI
-diabetes -age -male -LV dysfunction -cocaine abuse -renal insufficiency -valvular heart disease -sleep apnoea elevated - TNF alpha, CRP, natriuretic peptides, IL-6 decreased - IGF-1 |
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diagnostic tests for heart failure
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ECHO
ECG CXR BNP, NT-pro-BNP (N-terminal pro BNP) if high (>400ng/L) indicates abnormal LV funtion; if low (<100ng/L) rules out decompensated heart failure and indicates pulmonary cause FBC - amaemia and raised WCC are risk factors U&E - for baseline creatine, blood urea nitrogen - reflects tissue perfusion blood glucose - diabetes risk factor LFT - reflects abnormal congestion blood lipids - decreasing in end stage heart failure |
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lifestyle changes to make with heart failure
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reduce salt intake
fluid restriction continuous monitoring |
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main drugs used to treat heart failure
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-diuretics
-vasodilators -intropic agents -ACE-i -beta blockers -angiotensin II receptor blockers -aldosterone receptor antagonists |
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tell me more about
-diuretics... -vasodilators -intropic agents -ACE-i -beta blockers -angiotensin II receptor blockers -aldosterone receptor antagonists |
-loop diuretics
eg furosemide short duration of action (cf thiazides) inhibits reabsorption of Na+ and Cl- in THICK ASCENDING LIMB OF THE LOOP OF HENLE thereby preventing the generation of HYPERTONIC RENAL MEDULLA water has less of an OSMOTIC DRIVING FORCE to leave the COLLECTING DUCT increased urine production enhances Ca++ loss (cf thiazides which reduce Ca++ loss) side effects -electrolyte imbalance -ototoxicity (rare) |
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tell me more about
-diuretics -vasodilators -intropic agents.... -ACE-i -beta blockers -angiotensin II receptor blockers -aldosterone receptor antagonists |
eg digoxin
increases SV, ejection fraction decreases heart rate side effects -nausea, vomiting, diarrhoea |
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tell me more about
-diuretics -vasodilators -intropic agents -ACE-i -beta blockers -angiotensin II receptor blockers -aldosterone receptor antagonists... |
eg spironolactone
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more invasive option for heart failure treatment
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implantable cardiac defibrilator (ICD) - if no LBBB
biventricular pacemaker - if there is LBBB left ventricular assist device (LVAD) transplantation stem cells/myoblasts |
