what are the major criteria for CCF? 9
- paroxysmal nocturnal dyspnoea
- crepitations
- S3 gallop
- cardiomegaly
- increased central venous pressure
- weight loss in response to treatment
- neck vein distention
- acute pulmonary oedema
- hepatojugular reflux
what are the minor criteria for CCF? 7
- bilateral ankle oedema
- dyspnoea or ordinary exertion
- tachycardia
- decrease in vital capacity by 1/3 from maximum recorded
- nocturnal cough
- hepatomegaly
- pleural effusion
which investigations should be carried out for CCF? 6
- ECG
- B-ype natriuretic peptide
- FBC; U &E; BNP
- CXR
- echo
- endomyocardial biopsy is rarely needed
If ECG and B-type natriuretic peptide are normal, heart failure is _____ and an alternative diagnosis should be considered; if either is _____, then echocardiography is required
If ECG and B-type natriuretic peptide are normal, heart failure is unlikely and an alternative diagnosis should be considered; if either is abnormal, then echocardiography is required
what signs are possible of CXR? 8
- cardiomegaly
- prominent upper lobe veins
- peribronchial cuffing
- diffuse interstitial or alveolar shadowing
- bats wing
- fluid in the fissures
- pleural effusions
- septal line (kerley B lines)
what causes the septal lines (kerley B lines)
variously attributed to interstitial oedema and engorged peripheral lymphatics
the ecg may indicate cause, what causes may be shown on ecg?
look for evidence of ischaemia, MI, ventricular hypertrophy
Echocardiography is the key investigation. It may indicate the cause (___, _____-) and can confirm the presence or absence of ___ dysfunction.
Echocardiography is the key investigation. It may indicate the cause (MI, valvular heart disease) and can confirm the presence or absence of LV dysfunction.
specific causes of heart failure and their treatments:
what is the treatment for cor pulmonale?
Rx diuretics and oxygen only
specific causes of heart failure and their treatments:
what is the treatment for valvular disease?
surgery ideally
specific causes of heart failure and their treatments:
what is the treatment for fast AF?
digoxin or DC shock
If you have a bad ____ then drugs are not going to be helpful for you
If you have a bad valve then drugs are not going to be helpful for you
what are the drugs used in CCF? 4/2/3
- diuretics- to excrete retained fluid
- ACE inhibis
- B blockers
- Spironolactone - severe cases only
- digoxin
- other vasodilators (nitrates, hydralazine)
- ICD
- cardiac resynchronisation therapy
- transplantation
what is the first step in management?
lifestyle: stop smoking, eat less salt, optimise weight and nutrition
before drugs, what is done?
Treat the cause
Treat exacerbating factors
Avoid exacerbating factors
what are some exacerbating factors of CCF that should be treated before drug therapy?
anaemia, thyroid disease, infection, increased BP
what are some exacerbating factors of CCF that should be avoided before drug therapy?
NSAIDS (fluid retention) and verapamil (negative inotrope
Thiazide diuretics are used for ___ CCF only
mild
Loop diuretics are used to ____ symptoms
relieve
give an example of a very effective loop diuretic
furosemide
what is a side effect of furosemide?
- you may lose potassium
although furosemide makes you lose K, conincidental drugs like ACE inhibitors, spironolactone help to _____
conincidental drugs like ACE inhibitors, spironolactone help to retain and normalise K
_ levels must be checked regularly. Too high or too low ___ can both cause arrhythmias
K levels must be checked regularly. Too high or too low a K can both cause arrhythmias
In refractory oedema - consider adding a _____
thiazide
