2. Acute HF

Question 1

What is HF?

Answer 1

When the heart can’t pump enough to meet the demands of the body

Question 2

Two complications?

Answer 2

1. Pulmonary edema

2. Cardiogenic shock

Question 3

4 triggers

Answer 3

1. Iatrogenic: aggressive IV fluids in elderly patients
2. Sepsis
3. MI
4. Arrythmia

Question 4

6 symptoms

Answer 4

Rapid onset SOB, worse on exertion

Pleuritic chest pain

Orthopnea

Paroxysmal nocturnal dyspnea

Cough with frothy white or pink sputum

In severe cases, hypotension

Question 5

Type 1 vs Type 2 RF

Answer 5

T1 RF: damage to lung tissue prevents adequate oxygenation but there is enough functional lung tissue to excrete carbon dioxide

T2 RF: damage to lung tissue prevents adequate oxygenation and also removal of carbon dioxide

Question 6

3 examination findings in acute HF specific to respiratory system

Answer 6

Increased RR

Reduced oxygen sat

Bilateral basal course crackles

Question 7

Signs of RS HF vs LS HF

Answer 7

RS HF: backlog into body causing raised JVP and peripheral edema (sacrum, legs and ankles)

LS HF: backlog into lungs causing pulmonary edema

Question 8

Bloods and imaging?

Answer 8

Bloods:

Get ABG for RF

Always (FBC, UE, LFT, TFT, CRP, ESR)

Underlying cause (glucose, fasting glucose, hba1c, lipid profile)

Diagnostic (BNP)

Imaging: ECG, CXR, ECHO

Question 9

Describe the acronym acute HF is managed using?

Answer 9

POUR SOD

1. Pour Away (stop IV fluids, monitor intake of fluids, monitor urine output, get daily UE and weigh pt daily)
2. Sit up
3. Oxygen if 94% or lower (or 88% in T2 RF)
4. Diuretics: IV furesomide 40mg stat

Question 10

What does BNP stand for?

What type of molecule is it?

When is it released?

2 functions?

Answer 10

B-type natriuretic peptide

Hormone

Released by the left ventricles when myocardium is stretched

Diuretic to reduce circulating volume
Vasodilator to reduce systemic resistance

Question 11

Problems with BNP test

Answer 11

Sensitive but not specific

So if -ve, rules out HF, but if +ve could have other causes

Question 12

3 conditions a positive BNP can indicate other than HF?

Answer 12

Sepsis

PE

COPD

Question 13

How is left ventricle function assessed using ECHO?

Answer 13

Use ECHO to calculate ejection fraction

Question 14

What is EF?

Normal EF?

Answer 14

% blood squeezed out of left ventricle on contraction

Above 50%

Question 15

3 ways acute HF presents on CXR and why

Answer 15

Cardiomegaly (cardiothoracic ratio more than 0.5) due to LV hypertrophy

Upper lobe venous diversion due to backlog of blood

Visible interlobar fissures and septal lines (aka Kerley B lines) visible and bilateral pleural effusion due to edema

Question 16

What should you uncover in examination of a pt with suspected acute HF? Give examples.

Answer 16

Underlying cause:

Chest pain in ACS

Palpitations in arrythmia

Fever in sepsis

Question 17

In what 3 ways can severe acute HF or cardiogenic shock be managed?

Answer 17

Intravenous opiotes

Continuous Positive Airway Pressure to forcefully blow air into lung (if NIV doesn’t work, may need intubation and ventilation)

Inotropes like noradrenalin in specialist unit to increase strength of heart contractions

Question 18

2 examination findings in acute HF specific to heart

Answer 18

Tachycardia

3 heart sound - ‘gallop rhythm’