9. Heart failure - presentation

Question 1

Name 5 symptoms of left-sided HF.

Answer 1

1. extertional dyspnoea, orthopnea and paroxysomal nocturnal dyspnoea
2. fatigue and exercise intolerance
3. cough and blood-tinged sputum
4. cool peripheries
5. restlessness and confusion

Question 2

Name 7 signs of left-sided HF.

Answer 2

1. rales (crackles)
2. tachycardia
3. cyanosis
4. arrhythmias
5. displaced apex beat, functional murmur of mitral valve regurgitation and 3rd or 4th heart sound (‘gallop’ rhythm)
6. anaemia
7. increased serum urea/creatine

Question 3

Name 2 symptoms of right-sided HF.

Answer 3

1. fatigue

2. anorexia and GI distress

Question 4

Name 4 signs of right-sided HF.

Answer 4

1. jugular venous distension
2. hepatosplenomegaly (and liver failure)
3. ascites
4. pitting oedema in legs or sacrum

Question 5

Why would LHF cause cyanosis and tachycardia?

Answer 5

decreased CO

Question 6

Why would LHF cause arrhythmias?

Answer 6

LV hypertrophy and myocyte irritation

Question 7

Why would LHF cause displaced apex beat, mitral valve regurgitation murmur or 3rd/4th heart sounds?

Answer 7

cardiomegaly/LV dilation

Question 8

Why would LHF cause increased serum creatine and urea?

Answer 8

decreased renal perfusion and GFR causes kidney damage

Question 9

Why would LHF cause fatigue/exercise intolerance and dyspnoea?

Answer 9

i) increased peripheral arterial resistance causes decreased skeletal muscle blood flow…
ii) decreased skeletal muscle mass (cachexia) affecting all muscles inc. limbs and respiratory (e.g. diaphragm)

Question 10

Why would LHF cause respiratory signs and symptoms?

Answer 10

Decreased LV CO causes backup of blood in pulmonary veins and capillary bed, and Na/H2O retention due to RAAS… cause increased hydrostatic pressure in pulmonary artery and capillaries… fluid movement into interstitial space… pulmonary oedema.

1- rales (crackles) on auscultation
2- damage to pulmonary capillaries… blood-tinged sputum
3- decreased O2/CO2 exchange in alveoli… cough, dyspnoea/orthopnea

Question 11

Why does anaemia often occur in LHF?

Answer 11

1. chronic renal failure (as kidneys are important source of EPO)
2. chronic inflammatory disease
3. expanded plasma volume
4. drug therapy (ACEi/aspirin)
5. iron malabsorption

Question 12

Why would RHF cause jugular venous distension?

Answer 12

decresaed RV CO causes backup of blood in systemic venous circulation

Question 13

Why are ascites, anorexia/GI distress, hepatosplenomegaly and pitting peripheral oedema symptoms of RHF?

Answer 13

increased hydrostatic pressure in systemic venous circulation