Heart Failure mind maps

Heart Failure revision notes

Pathophysiololgy

• Heart Failure with reduced ejection fraction (HFrEF)- EF < 50%. 
  
• Heart Failure with preserved ejection fraction (HFpEF)
• up regulation of Renin-Angiotensin-Aldosterone System
• Increased catecholaemines
• Cardiomyopathies
• valve disease

Investigaitons

Bloods: 

• Natriuretic peptides- BNP / NTproBNP. 
  
• Renal function - renal dysfunction common
  
• Haemoglobin- exclude anaemia
  

ECG

• Atrial fibrillation
• QRS + sinus rhythm + EF <35% + NYHA >II- CRT

CXR

• upper lobe diversion
• cardiomegaly
• alveolar oedema/ interstitial oedema= Kerly B lines, patchy opacification
  
• Pleural effusions

ECHO

• Ejection fraction
• valve disease
• cardiomyopathy (dilated)
• differential diagnosis- pericardial effusion/ constriction, cor pulmonale

Other tests

• Angiography- ? IHD
• MRI- structure and function
• Radionucleotide - ? function
• Biopsy

Clinical features

Symptoms- SOB/fatigue/ oedema
NYHA (New York Heart Association):

• I= no limitation of physical activity
• II= Mild symptoms on  exertion
• III= marked symptoms on exertion
• IV- symptoms at rest

PND - paroxsysmal nocturnal dyspnoea
Orthopnoea
Peripheral oedema

SIGNS
Peripheral oedema
Raised JVP
Third heart sound
Displaced Apex
pulmonary crackles / wheeze
tachycardia

Management- Chronic

HFrEF

• A- ACE inhibitor/ ARB- all patients, improves life expectancy, reduces hospitalisations

• B- Beta blocker- all patients, improves life expectancy , reduces hospitalisations
• C- Cardioverter defibrillator (ICD) / CRT (cardiac resynschronisation) - EF <35% plus NYHA II-IV
• D- Diuretics -loop +/- thiazide if persistent pedema- for symptom relief
• E- everything else- MRA (mineralocorticoid receptor antagonists)- spironolactone/ eplerenone. HFLN (heart failure liaison nurses). Ivabradine   

HFpEF

• No proven treatment to reduce mortality
• Diuretics for symptoms

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