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Heart failure Flashcards

1
Q

What does late gadolinium enhancement tell you on MRI?

A

Shows regional but not diffuse myocardial fibrosis

means irreversible injury

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2
Q

BNP in heart failure

A

Negative rules out
Positive means need to select further tests
High levels = greater risk CV events
Can adjust treatment to reduce n peptides and MAY improve outcomes

Most cost effective in 60-75 year olds with fewer than 2 comorbidities

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3
Q

Main cause of diastolic heart failure

A

Hypertension

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4
Q

Rule of 2s in heart failure education

A

more than 2kg in 2 days call doctor
2g salt
2L fluid

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5
Q

High quality evidence for what 5 things in systolic heart failure?

A 
ACEi
beta blockers for II and III
Angiotensin 2RB
dedicated MDT
Bivent pacing, AICD
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6
Q

What has the biggest mortality benefit?

A

BETA BLOCKERS

then spironolactone
then ACE/ARB

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7
Q

How does ivabradine work?

A

Acts on funny channel in SA node

in heart failure II or III with impaired systolic function less than 35% AND recent HF hosp AND HR over 70 despite max beta block/max tolerated

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8
Q

What does BNP do?

A

BNP produces arterial and venous vasodilation

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9
Q

Ivabradine effects/outcomes?

A

Reduce cardiovascular deaths/heart failure admissions

Reduce all cause hosp admissions

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10
Q

ANP good guy or bad guy?

A

Good guy!

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11
Q

AICD indications

A

Survived a VF arrest due to a not transient or reversible cause
Sustained VT and structural heart disease
LVEF under 35 percent more than one moth post MI ro three months post CAGs and nyha 2 or 3
LVEF under 35% and symptomatic CHF NYHA 2-3

not if not going to survive a year

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12
Q

Bivent pacing indications

A

Ischaemic or dilated+ NYHA 3-ambulatory 4 + LVEF +QRS over 120 + sinus + EF 35%
AF same but “reasonable”
NYHA 2 + LVEFunder30 + QRS over 150 with LBBB morphology

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13
Q

What do ACEi, aldo antag, beta blockers all do?

A

Reduce symptoms
Reverse remodelling
Reduce heart failure death and sudden death

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14
Q

What do diuretics and digoxin do?

A

Symptom benefit ONLY THING!

No mortality or remodelling benefit

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15
Q

MDTs do what?

A

Prevent clinical deterioration

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16
Q

Restrictive cardiomyopathy- suspect AMYLOID when

A

predom RHF
left ok
unexplanined increase in vent wall thickness
atria dilated and afib common

17
Q

Is low EF an indication for heart transplant?

A

No not alone

Have to stop smoking
Hep and HIV not absolute contraindications
Morbid obesity and poor diabetes are contraind

18
Q

Number one indication for heart transplant?

A

Idiopathic ahead of ischaemic by a bit

40%

19
Q

Characteristics of transplant coronary disease vs regular coronary disease?

A

Diffuse
Distal
Non calcified
concentric (not eccentric)

20
Q

Main benefit of a heart transplant?

A

Survival- mean without is under 2 years. Median ANZ is 4 years.

21
Q

Stages of heart failure

A

Stage A- high risk of heart failure but no structural or symptom changes
Stage B- Structural heart disease without signs or symptoms
Stage C- Structural heart disease and prior or current symptoms
Stage D- Refractory heart failure

22
Q

Explain E and A

A

E is passive ventricular filling
A is filling from the atrial kick.

EA very high in AF
Normally A is more than E

Grade 1 - abnormal relaxation with E less than A
Grade 2 - pseudonormal as the E to A looks normal
Grade 3 - restrictive filling E:A more than 3:1

23
Q

Start a beta blocker, then…

A

Clinical deterioration first 1-2 months

24
Q

Ivabradine side effects

A

Visual disturbance
QT looks longer because HR slows but no actual torsades effect
bradycardia
AF

25
Q

DCM is from mutations in what when it is the AD form?

A

sarcomere genes in 30% cases

Can also have cardiac conduction system disease in LMNA mutation sin people with DCM

26
Q

Alcoholic vs cirrhotic cardiomyopathy?

A

Alcoholic- dilated

Cirrhotic- more normal LV size

27
Q

What do pacemaker codes mean?

First second third fourth fifth

A

1- chamber paced

  1. chamber sensed
  2. response to sensing
  3. Rate modulation (R= rate adaptive o=not)
  4. multi-site pacing
28
Q

Heart transplant highest mortality
first 30 days
6-12 months
after one year

A

graft failure
infection
allograft vasculopathy

Cards (16 decks)

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