Acute and Chronic cardiac failure

Question 1

What is acute heart failure?

Answer 1

• Life threatening emergency

* Sudden onset or worsening symptoms of heart failure

Question 2

What is the symptoms of acute heart failure?

Answer 2

Dyspnoea
Reduced exercise tolerance
Oedema
Fatigue
Orthopnoea
Paroxysmal nocturnal dyspnoea

**Sometime presentation will be that of the underlying cause

Question 3

What are the signs of acute heart failure?

Answer 3

Cyansis
Tachycardia
Tachypnoea
Elevated JVP
Displaced apex beat
Bibasal crackles +/- wheeze
S3 heart sound

Question 4

What is the diagnostic investigation for patients you suspect to have acute heart failure?

Answer 4

• Blood tests: Cardiac, U&Es, LFTS, Clotting, FBC
• Chest X-Ray
• Eco
• B-typ natriuretic peptide (raised >100mg/l)

Question 5

What are the most common causes of decompensated heart failure presentations of acute heart failure?

Answer 5

• Acute coronary syndrome
• Hypertensive crisis
• Acute arrhythmia
• Valvular disease

Question 6

What are the causes of de-novo acute heart failure?

Answer 6

• Viral myopathy
• Toxins
• valve dysfunction

Question 7

What is the acute management of heart failure?

Answer 7

1. A-E assessment + investigations
2. Oxygen
3. IV loop diuretics bolus (furosemide/bumetanide)
4. Vasodilators
5. Inotropic agents
6. CPAP

*Consideration given to discontinue beta-blockers in short term

Question 8

What are the signs on a chest x-ray that suggest heart failure? ABCDE mnemonic

Answer 8

A = Alveolar oedema
B = Kerley B line
C =Cardiomegaly 
D = Diagonal left atrium + dilated upper lobe vessels
E =pleural Effusion

Question 9

What scoring system is used to classify heart failure?

Answer 9

The New York heart association classification

Question 10

What is New York heart association class 1?

Answer 10

• no symptoms

* no limitation: ordinary physical exercise does not cause undue fatigue, dyspnoea or palpitations

Question 11

What is New York heart association class 2?

Answer 11

• mild symptoms
• slight limitation of physical activity: comfortable at rest but ordinary activity results in fatigue, palpitations or dyspnoea

Question 12

What is New York heart association class 3?

Answer 12

• moderate symptoms

* marked limitation of physical activity: comfortable at rest but less than ordinary activity results in symptoms

Question 13

What is New York heart association class 4?

Answer 13

• severe symptoms
• unable to carry out any physical activity without discomfort: symptoms of heart failure are present even at rest with increased discomfort with any physical activity

Question 14

What is the management of chronic heart failure?

Answer 14

1st line:
>ACEi and B-blocker

2nd line:
>Aldosteone antagonist i.e. spironolactone and eplerone

3rd line (specialist)
>Digoxin
>Ivabradine
>Sacubitril

Question 15

What is looked at to diagnose chronic heart failure diagnosed?

Answer 15

*All patients have a N-terminal pro-B type natriuretic peptide (NTproBNP)
>Levels high seen within 2 weeks

*Also look at BNP levels

Question 16

What are the signs of chronic right sided heart failure?

Answer 16

• Peripheral ankle oedema
• Hepatomegaly
• Raised JVP

Question 17

What is the presentation of chronic left sided heart failure?

Answer 17

• Dyspnoea
• Cough worse at night : pick/frothy sputum
• Orthopnoea
• Paroxysmal nocturnal dyspnoea
• Wheeze
• Weight loss (cardiac cachexia) sometimes hidden by oedema
• Bibasal crackles on exam