6. LV failure

Question 1

How common is it?

Answer 1

1% of >65s have heart failure

Question 2

What causes it?

Answer 2

Coronary artery disease –> scarring
HTN (esp. if poorly controlled) –> hypertrophy
Arrhythmias, cardiomyopathies

Question 3

What risk factors are there?

Answer 3

Diabetes
Smoking
Obesity
Sedentary lifestyle

Question 4

What risk factors are there?

Answer 4

Diabetes
Smoking
Obesity
Sedentary lifestyle
High salt intake

Question 5

How does it present?

Answer 5

SOB
Orthopnoea
PND
Symptoms of volume overload

Question 6

What signs may the patient have on examination?

Answer 6

Crackles / decreased breath sounds on lung auscultation
Raised JVP
Positive hepatojugular reflux
Low bp, tachycardia
Oedema

Question 7

What other conditions might present similarly?

Answer 7

Pulmonary hypertension
COPD
Anaemia
Venous insufficiency / DVT (lower limb oedema)

Question 8

How would you investigate?

Answer 8

Troponin, FBC, LFTs, U+Es
ECG, BNP
Coronary angiogram
Echo

Question 9

What treatments are there?

Answer 9

Lifestyle modification
Loop diuretics, ACEis, B blockers
Meralocorticoid receptor antagonists eg spironolactone, digoxin, vasodilators

Question 10

What complications are there?

Answer 10

Respiratory distress
Arrhythmias
Cardiogenic shock
Sudden death