A7- Heart Failure

Question 1

What are the different types of heart failures

Answer 1

Question 2

Preserved EF does not equal preserved CO

TRUE OR FALSE

Answer 2

TRUE

Question 3

HF assessment - evaluation of the whole body

What do you check for?

Answer 3

Fluid

• CVP/JVP/Urine output/auscultation
• Oedema - chronic? -lymphoedema?
• Nephrotic/urine dipstick/intravascular volume evaluation
• NT-pro BNP

Metabolic

• Lactate • BE/HCO3
• Hepatic ischaemia
• Pre-renal renal failure
• Venous blood Gas – Sats/CO/C;

Question 4

What are the Ongoing daily assessment for a patient with heart failure

Answer 4

• Renal: Na/K/Urea/Creatinine/eGFR
• Hepatic: Bilirubin/ALT/ALP/albumin
• Inflammatory/infection: Immunocompromised - CRP
• Others: FBC/PLT/WCC
• Physical: Input/output/Balance – often not catheterised, Weight and weight trend from baseline, CVP in held expiration
• Arrhythmias/VT
• Rarely an arterial line

Question 5

What are the imaging for HF

Answer 5

Echocardiography • LV function • Valves - acute decompensation • Effusion/tamponade • VSD • Chordae rupture • Others

Question 6

What medications are used in HF

Answer 6

• Diuretics (IV in the community) - frusemide/bumetanide/metolozone/BFZ
• ACEi/ARBi
• BB

• Entresto/ARNI

• MRA

• Sinus node/If inhibitor
• Glycoside/digoxin
• IV Iron replacement
• Hydralazine
• Anticoagulants
• Anti-arrhythmics

• Beta Blocker

Question 7

Which diuretics directly target the thick acending limb

Answer 7

loop diuretics

Question 8

Which diuretics directly target the proximal convoluted tubule

Answer 8

Carbinic anhydrase inhibitors

Question 9

Which diuretics directly target the distal convulted tubule

Answer 9

Thiazides

Question 10

Which diuretics directly target the collecting ducts

Answer 10

K+ sparing diuretics

Question 11

Name Advanced Heart Failure Therapies

Answer 11

• Inotropes
• Haemofiltration
• Tandem/Impella/IABP
• VA-ECMO
• LTVAD/BiVAD
• Heart Transplantation