3: Heart failure

Question 1

What is another name for heart failure?

Answer 1

Congestive cardiac failure (CCF)

Question 2

CCF is a (disease / collection of diseases).

Answer 2

collection of diseases

Question 3

What is the main cause of CCF?

Answer 3

Low cardiac output

Question 4

What are the three types of congestive cardiac failure (CCF)?

Answer 4

a) Left heart failure
b) Right heart failure
c) Mixed

Question 5

An example of acute left heart failure is…

Answer 5

left ventricular failure.

Question 6

CCF can be either acute or ___.

Answer 6

chronic

Question 7

Signs and symptoms associated with CCF usually come about due to ___ ___.

Answer 7

fluid retention

Question 8

Name three cardiac conditions which cause left heart failure.

Answer 8

Ischaemic heart disease » myocardial infarction

Cardiomyopathy

Valvular disease

Question 9

Right sided heart failure is ___ to left heart failure.

Answer 9

secondary

Question 10

Name two cardiac conditions which cause right sided heart failure.

Answer 10

Cor pulmonale

Congenital heart disease

Question 11

What are some symptoms of left sided heart failure?

Answer 11

• Dyspnoea on exertion/rest
• Orthopnoea
• PND (paroxysmal nocturnal dyspnoea)
• Pulmonary oedema
  
  • sudden dsypnoea, PINK FROTHY SPUTUM

Question 12

What are some clinical signs of left sided heart failure?

Answer 12

Tachycardia

Fine crepitations

Pleural effusion

Third heart sound

On a CXR you may see cardiomegaly, bats wing shadows in the lower zones and interstitial fluid.

Question 13

What is a clinical symptom of right sided heart failure?

Answer 13

Oedema (ankle / sacral)

Question 14

What are some clinical signs of right sided heart failure?

Answer 14

Oedema (ankles / sacral)

Elevated JVP (>4cm above sternal angle)

Hepatomegaly

Ascites (fluid build up in peritoneal cavity)

Question 15

What would you see on the CXR of a patient with right sided heart failure?

Answer 15

Nothing, it would be normal

Question 16

CCF related to MI and cardiomyopathy have a standard treatment pathway.

How would you treat:

• cor pulmonale
• valvular disease
• fast atrial fibrillation

Answer 16

Cor pulmonale → Diuretics and O₂ only

Valvular disease → Surgery

Fast AF → Digoxin (slows HR) & shock to restore sinus rhythm

Question 17

What drugs are used in the standard medical treatment for CCF?

Answer 17

Diuretics to excrete retained fluid

ACE Inhibitors

Beta blockers

Spironolactone (in severe cases)

Digoxin

Vasodilators (nitrates)

Question 18

What are some common surgical / mechanical interventions used to treat CCF?

Answer 18

Implantable cardiac defibrillators

Cardiac resynchronisation therapy

Transplantation

Question 19

What is a loop diuretic commonly used to treat CCF?

Answer 19

Furosemide

Question 20

A common side effect of loop diuretics (e.g furosemide) is hypokalaemia - what other drugs used in CCF therapy help to prevent this?

Answer 20

ACE Inhibitors

Spironolactone

Question 21

What do ACE inhibitors do?

Answer 21

Prevent the conversion of Angiotensin I → Angiotensin II by ACE.

Question 22

Name some common ACE inhibitors.

Answer 22

Captopril, enalapril, lisinopril

Question 23

An alternative to ACE Inhibitors is Angiotensin II receptor blockers (ARBs) - give some examples.

Answer 23

Losartan, valsartan

Question 24

Why would you use an ARB as opposed to an ACE inhibitor?

Answer 24

If the patient had a cough as a result of the ACE Inhibitor

Question 25

Beta blockers are good for CCF in the long term but can ___ it in the short term.

Answer 25

**worsen**

Question 26

What are some initial risks of using a beta blocker in someone with CCF?

Answer 26

**Hypotension** **Progressive dyspnoea**

Question 27

Give an example of a **B₁ blocker** used in CCF.

Answer 27

**Bisoprolol**

Question 28

An important quality of **bisoprolol** is that it is ____ - why?

Answer 28

**cardioselective** Binds to B₁ adrenoceptors only

Question 29

**Spironolactone** is an \_\_\_-receptor antagonist.

Answer 29

**aldosterone**

Question 30

What does **ivabradine** do?

Answer 30

**Slows heart rate**

Question 31

Ivabradine should only be used to slow the heart rate if an attempt has already been made with ___ \_\_\_.

Answer 31

**beta blockers**

Question 32

Research reckons that which drug will replace ACE Inhibitors in treating CCF?

Answer 32

**Sacubitril-Valsartan** | (Neprilysin inhibitor and ARB)

Question 33

**Sacubitril-Valsartan** should never be used in combination with which type of drug?

Answer 33

**ACE Inhibitor**

Question 34

**Digoxin** is used to slow down fast ___ \_\_\_.

Answer 34

**atrial fibrillation**

Question 35

While digoxin is useful in calming AF before it is shocked, it also has some negative effects on the heart - what are they?

Answer 35

**Heart block** **Ventricular arrhythmias**

Question 36

What therapy should be given to a patient who is suffering **acute left sided heart failure**?

Answer 36

**1. Sit up** **2. Oxygen\*** **3. IV furosemide** **4. IV diamorphine\*** \* COPD - 2 be careful, 4 absolutely not