Acute Heart Failure

Question 1

What type of situation is acute heart failure?

Answer 1

Life threatening emergency

Question 2

What is acute heart failure?

Answer 2

Sudden onset or worsening of the symptoms of heart failure.

Question 3

How can acute heart failure occur?

Answer 3

With or without a background of chronic heart failure

Question 4

What is the term for acute heart failure presenting without a background of chronic heart failure?

Answer 4

De-novo acute heart failure

Question 5

What is the term for acute heart failure presenting on a background of chronic heart failure?

Answer 5

Decompensated heart failure

Question 6

What is acute heart failure due to?

Answer 6

Reduced cardiac output that results from a functional or structural abnormality.

Question 7

What are the main precipotating factors for decompensated acute heart failure?

Answer 7

Acute coronary syndrome
Hypertensive crisis
Acute arrhythmia
Valvular disease

Question 8

What investigations can be done for acute heart failure?

Answer 8

Blood tests
Chest X-ray
Echocardiogram
B-type natriuretic peptide

Question 9

Why would you do a blood test in someone presenting with acute heart failure?

Answer 9

To look for
–Anaemia
–Abnormal electrolytes
–Infection

Question 10

What would you look for on a chest x-ray of someone with acute heart failure?

Answer 10

Pulmonary venous congestion
Interstitial oedema
Cardiomegaly
Bilateral pulmonary oedema

Question 11

When would you carry out an echocardiogram for someone presenting with acute heart failure?

Answer 11

New-onset heart failure
Known heart failure who have a suspected change in cardiac function

Question 12

What level of BNP would be supportive of diagnosis of acute heart failure?

Answer 12

raised levels (>100mg/litre) indicate myocardial damage and are supportive of the diagnosis.

Question 13

When would you suspect acute heart failure?

Answer 13

Breathless desaturating patient who has been gievn fluids

Question 14

What is an example patient of acute heart failure?

Answer 14

85 year old patient with chronic kidney disease and aortic stenosis is prescribed 2 litres of fluid over 4 hours and then starts to drop her oxygen saturation

Question 15

What type of blood gas does acute heart failure cause?

Answer 15

Type 1 respiratory failure (low oxygen without an increased carbon dioxide).

Question 16

What is acute heart failure in simple terms?

Answer 16

Acute failure of the LV

Question 17

What are the main symptoms of acute heart failure?

Answer 17

Shortness of breath- esp on exertion
Cough with frothy white or pink sputum
Orthopnoea
Bilateral basal crackles
Paroxysmal nocturnal dyspnoea

Question 18

What signs might you find on examination of someone with acute heart failure?

Answer 18

Raised respiratory rate
Reduced oxygen saturations
Tachycardia
3rd heart sound
Bilateral basal crackles
Hypotension in severe case

Question 19

When might a patient with acute heart failure become hypotensive?

Answer 19

Cardiogenic shock

Question 20

What is the initial management of someone presenting with acute heart failure

Answer 20

IV loop diuretics
e.g. furosemide or bumetanide

Question 21

What would you administer to patients with respiratory failurue in acute heart failure?

Answer 21

CPAP

Question 22

What else can be given to a patient with acute heart failure?

Answer 22

oxygen
To keep saturations between 94-98%

Question 23

When would you consider giving vasodilators to someone with acute heart failure?

Answer 23

Concomitant myocardial ischaemia
Severe hypertension
Regurgitant aortic or mitral valve disease

Question 24

What is a major side effect of vasodilators?

Answer 24

hypotension

Question 25

What are the main heart features that might suggest acute heart failure?

Answer 25

S3 heart sound
Displaced apex beat
tahcycardia