7. Heart Failure

Question 1

How is heart failure defined

What is used to scale it’s severity?

Answer 1

Cardiac output inadequate for the body’s requirements

New York classification

Question 2

How does the New York classification scale differentiate types of heart failure?

Answer 2

I- heart disease present but no undue dyspnoea
II-dyspnoea during normal activities
III- less than ordinary activity causing dyspnoea
IV- dyspnoea present at rest

Question 3

What are the two types of heart failure?

Answer 3

Left heart failure vs right heart failure

Question 4

What are the symptoms of left heart failure?

Answer 4

Dyspnoea
Poor exercise tolerance
Orthopnoea
Paroxysmal nocturnal dyspnoea 
Pink frothy sputum

Question 5

What are the symptoms of right heart failure?

What causes right heart failure?

Answer 5

Peripheral oedema
Ascites
Nausea
Anorexia

LVF, pulmonary stenosis, lung disease, pulmonary stenosis, cor pulmonale

Question 6

What may be some further features of heart failure?

Answer 6

Cyanosis
Low blood pressure
Displaced apex
Heave

Question 7

What investigations are done for heart failure?

Answer 7

ECG and BNP (>50 possible, >100 definitive) are major ones-if normal not heart failure
CXR
U&E’s
ECHO

Question 8

What changes of heart failure are seen on a chest x-ray?

Answer 8

A- alveolar oedema (bat wings)
B- kerley B lines (kardi b lines)
Ç-cardiomegaly
D- dilated upper lobe veins 
E-pleural effusions

Question 9

What lifestyle changes can treat heart failure?

Answer 9

Stop smoking
Stop drinking alcohol
Eat less salt
Optimise weight and nutrition

Question 10

What non pharmacological approaches can be taken to treat heart failure

Answer 10

Treat the underlying causes
Treat exacerbating factors
Avoid exacerbating factors
Annual flu vaccine, pneumococcal vaccine

Question 11

What drugs are given in heart failure?

Answer 11

Diuretics- help symptoms, not mortality.

Ace-I

B-blockers- start low and go slow

Mineralocorticoid receptor agonists, digoxin, vasodilator