Acute LVF, Pulmonary Oedema, HF

Question 1

Triggers of LVF (4)

Answer 1

Myocardial Infarction
Arrhythmias
Sepsis
Iatrogenic (e.g. aggressive IV fluids in frail elderly patient with impaired left ventricular function)

Question 2

Symptoms of LVF (6)

Answer 2

SOB
Looking or feeling unwell
Cough (frothy white/pink sputum)

Underlying cause:
Chest pain (ACS)
Fever (Sepsis)
Palpitations (Arrhythmias)

Question 3

Examination findings in acute LVF (6)

Vitals - 4

Auscultate -2

Answer 3

Increase respiratory rate
Reduced oxygen saturations
Tachycardia
Hypotension in severe cases (cardiogenic shock)

3rd Heart Sound
Bilateral basal crackles (sounding “wet”)

Question 4

Signs of right sided heart failure (2)

Answer 4

Raised JVP

Pitting or sacral oedema

Question 5

What is BNP?

Answer 5

B-type Natriuretic Peptide
Released from ventricles when the cardiac muscle (myocardium) is stretched beyond the normal range
High result indicates the heart is overloaded beyond its normal capacity to pump effectively

Question 6

What does BNP do? (3)

Answer 6

Relaxes smooth muscle in blood vessels

Reduces the systemic vascular resistance

Acts on the kidneys as a diuretic to promote the excretion of more water in the urine

Question 7

Causes of raised BNP (9)

Answer 7

HF, HTN, Tachycardia

Sepsis

PE, COPD, Pneumonia, ARDS

Renal impairment

Question 8

What is the management of acute LVF?

Answer 8

Pour SOD
Pour away (stop) IV fluids 
Sit up
Oxygen
Diuretics (IV furosemide 40mg stat)

Question 9

What is chronic heart failure?

Answer 9

Impaired left ventricular contraction (“systolic heart failure”) - results in a chronic back-pressure of blood trying to flow into and through the left side of the heart

Impaired left ventricular relaxation (“diastolic heart failure”)

Question 10

How does heart failure present?

Answer 10

Breathlessness worsened by exertion
Cough (may produce frothy white/pink sputum)
Orthopnoea
Paroxysmal Nocturnal Dyspnoea
Peripheral oedema

Question 11

What is paroxysmal nocturnal dyspnoea?

Answer 11

Sudden waking at night with a severe attack of shortness of breath and cough

Question 12

What causes HF? (4)

Answer 12

Ischaemic Heart Disease
Valvular Heart Disease (commonly aortic stenosis)
Hypertension
Arrhythmias (commonly atrial fibrillation)

Question 13

What is the first line medical treat of HF?

Answer 13

ABAL

Ace inhibitor
Beta blocker
Aldosterone antagonist (spironolactone)
Loop diuretics

Question 14

When is ACEi avoided?

Answer 14

In patients with valvular heart disease

Question 15

When are aldosterone antagonists used?

Answer 15

When there is a reduced EF +

When symptoms are not controlled by ACEi and BB

Question 16

What is cor pulmonale?

Answer 16

Right sided HF caused by respiratory disease

Pulmonary hypertension results in the right ventricle being unable to effectively pump blood out of the ventricle
Back pressure of blood in the right atrium, vena cava and the systemic venous system

Question 17

What are the respiratory causes of cor pulmonale?

Answer 17

COPD (most common cause)
Pulmonary Embolism
Interstitial Lung Disease
Cystic Fibrosis
Primary Pulmonary Hypertension