Cardio History
 

Heart Failure

 
 
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Overview

  • Heart failure can be functionally debilitating, though proper management can have a significant positive effect on a patient's mortality risk and quality of life.
    • Ask About

    • Diagnosis - when heart failure was diagnosed, symptoms, cause
    • Severity - exercise tolerance / NYHA class, ejection fraction
    • Functional impact of disease
    • Management - non-pharmacologic, pharmacologic, devices
    • Complications - arrhythmias, peripheral oedema, pulmonary oedema, pulmonary hypertension
    • Causes of Heart Failure

    • Ischaemic heart disease
    • Cardiomyopathy
    • Myocarditis
    • Pericardial disease
    • Valvular disease
    • Congenital heart disease
    • Hypertension
    • Precipitants of Heart Failure

    • Arrhythmias
    • Infection
    • Anaemia
    • Myocardial infarction
    • IV fluid excess
    • Alcohol
    • Thyrotoxicosis
    • Surgery
    • Pregnancy

Diagnosis

    • Classification

    • Heart failure with reduced ejection fraction (HFrEF)
    • Heart failure with preserved ejection fraction (HFpEF)
    • Symptoms of Heart Failure

    • Fatigue
    • Dyspnoea
    • Orthopnoea
    • Paroxysmal nocturnal dyspnoea
    • Reduced exercise tolerance
    • Peripheral oedema

Severity

    • Ask About

    • Exercise tolerance - use NYHA classes
    • Recent echocardiogram results - ejection fraction, regional wall motion abnormalities, valvular dysfunction
    • New York Heart Association Classes

    • I
      No limitation of physical activity; ordinary physical activity does not cause symptoms
    • II
      Slight limitation of physical activity; comfortable at rest though ordinary physical activity causes symptoms
    • III
      Marked limitation of physical activity; comfortable at rest though less than ordinary activity causes symptoms
    • IV
      Unable to carry out any physical activity without discomfort; symptoms are present at rest and increase with any physical activity

Complications

    • Complications of Heart Failure

    • Arrhythmias - atrial fibrillation, ventricular arrhythmias
    • Stroke
    • Sarcopaenia
    • Left Heart Failure

    • Pulmonary oedema
    • Pulmonary hypertension
    • Right Heart Failure

    • Ascites
    • Peripheral oedema
    • Cardiac cirrhosis

Management

    • Management Options

    • Non-Pharmacologic

    • Cardiac rehabilitation
    • Low sodium diet
    • Fluid restriction
    • Smoking cessation
    • Weight loss
    • Pharmacologic

    • ACE inhibitors (ACEi) - captopril, ramipril, perindopril
    • Angiotensin II receptor blockers (ARBs) - candesartan, irbesartan
    • Beta blockers - carvedilol, metoprolol, bisoprolol, nebivolol
    • Aldosterone antagonists - spironolactone
    • Loop diuretics - frusemide
    • Ivabradine
    • Digoxin
    • Devices

    • Biventricular pacing
    • Automatic implantable cardioverter defibrillator
    • Surgical Options

    • Heart transplant
 
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