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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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