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25 Cards in this Set
- Front
- Back
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Define heart failure |
Inability of the heart to keep up with the demands on it and in particular, inability to provide oxygenated blood to the organs that require it Inability to provide adequate blood flow to other organs such as the brain, liver and kidneys |
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List 7 causes of heart failure |
Ischaemic heart disease Cardiomyopathies Hypertension Arrhythmias Valvular disease Drugs eg.chemo Thyrotoxicosis/anaemia |
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List 4 consequences of heart failure |
Salt and water retention Increasing myocardial oxygen demand Endothelial dysfunction Prothrombosis |
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How many 40 year olds will develop HF? |
1 in 5 |
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If HF is symptomatic, What is mortality? |
50% in 2 years |
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List the 5 main symptoms of HF |
Fatigue Activities Chest congestion Edema/leg swelling Shortness of breath |
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List 4 other symptoms of HF |
Nocturia Swollen abdomen Confusion Memory impairment |
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What specific question should you ask someone suspicious of HF? |
How many pillows they sleep with and if they have to get up during the night with breathing difficulties |
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State an early symptom of HF |
Orthopnoea - sob on lying flat relieved by sitting up |
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How does orthopnoea manifest in a HF patient? |
Blood is redistributed to lungs on lying flat LV cannot pump extra volume causing pulmonary congestion |
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List another symptom of HF at night |
Paroxysmal nocturnal dyspnoea |
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Differentiate between the two classes of HF |
HF-REF: reduced ejection fraction caused by a weak heart muscle pump - pumping problem HF-PEF: preserved ejection fraction, stiff heart muscle - primarily a filling problem |
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List 4 examinations and common findings of each in HF |
Inspection: raised JVP in neck, ascites Palpation: tachycardic pulse in congestive HF, pitting oedema, hepatomegaly in RHF Percussion: pleural effusions, ascites and hepatomegaly Auscultation: S3 gallop (abnormal heart sound with 3 components - kentucky) |
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List a common finding in HF ECGs |
Q waves and T-wave inversion suggesting previous ischaemia |
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List 7 investigations you could use to investigate HF |
ECG CxR Echo BNP Bloods cMRI Angiogram |
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List 3 common findings in a HF CxR |
Cardiomegaly Upper lobe diversion Pleural effusion |
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What marker in the blood is raised in HF? |
BNP (brain natruiretic peptide) |
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How does BNP work? |
Released from ventricles in response to stretch Acts to decrease systemic vascular resistance Increases loss of sodium and water Decreases blood volume BNP>100pg/ml suggest HF |
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What would you check for in bloods in suspected HF? |
FBC for anaemia U&E's for kideny function TFTs for thyrotoxicosis |
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What is cMRI good for looking at? |
Scarring Previous MI Size of ventricles and atria |
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What 6 treatments improve prognosis in HF-REF? |
ACE inhibitors Beta blockers Aldosterone antagonists Ivabradine ICD Cardiac resynchronisation |
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Which 2 drugs can be used to treat symptoms in HF? |
Loop diuretics Digoxin |
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How do ACE inhibitors improve prognosis? |
Decrease pre-load on heart via vasodilation Also reduce adverse remodelling of heart Enalapril is the best (CONSENSUS study) |
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How do BBs improve prognosis? |
Decrease HR and hence decrease oxygen demand on the heart |
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How do ICDs work? |
VT or VF is detected Shocks the heart back into sinus rhythm |
