Cardiac failure

Question 1

What is cardiac failure

Answer 1

failure of the heart to maintain the CO required to meet the bodys demands

Question 2

What is congestive heart failure

Answer 2

Both left and right heart failure

Question 3

What is meant by a low output state

Answer 3

heart fails to pump in response to normal exertion

Question 4

What is meant by a high output state

Answer 4

CO is normal but there are higher metabolic needs

Question 5

What ways can cardiac failure be classified by

Answer 5

ejection fraction
time
left/right

Question 6

How is cardiac failure classified by EF

Answer 6

patients may have normal or abnormal LVEF

• affects around 50% of people with HF

Question 7

How is LVEF measured and what defines a reduced LVEF

Answer 7

measured using echocardiography
<35-40%

Question 8

What kind of patients usually have systolic dysfunction and what causes it

Answer 8

patients with reduced LVEF

ischemic heart disease
dilated cardiomyopathy
myocarditis
arrhythmias

Question 9

What kind of patients usually have diastolic heart failure and what causes it

Answer 9

patients with preserved LVEF

hypertrophic obstructive cardiomyopathy
restrictive cardiomyopathy
cardiac tamponade
constrictive pericarditis

Question 10

How is heart failure classified temporally

Answer 10

usually described as being acute or chronic

Acute - refers to acute exacerbation of chronic heart failure

Question 11

What are the most urgent symptoms of acute heart failure

Answer 11

pulmonary oedema - often due to left ventricular failure

Question 12

What usually causes left sided heart failure

Answer 12

HF-rEF and HF-pEF

due to increased left ventricular afterload or increased left ventricular preload

Question 13

What usually causes right sided heart failure

Answer 13

increased right ventricular afterload
increased right ventricular preload

Question 14

What may someone with left heart failure present with

Answer 14

RESP SYMPTOMS

increased heart and resp rate
arrhythmias
dyspnoea
nocturnal cough - pink frothy sputum
fatigue

Question 15

What may someone with right heart failure present with

Answer 15

SWELLING SYMPTOMS

swelling
fatigue
raised JVP
reduced exercise tolerance
anorexia
nausea
nocturia
ascites

Question 16

What criteria can be used to make a clinical diagnosis

Answer 16

Framingham criteria

2+ MAJORS
OR
1 major and 2 minors

Question 17

What does the criteria for diagnosing heart failure include

Answer 17

Major
-paroxysmal nocturnal dyspnoea
-bibasal crepitation
-S3 gallop
-cardiomegaly
-increased central venous pressure
-weight loss
-neck vein distension
-acute pulmonary oedema
-hepatojugular reflux

Minor
-bilateral ankle oedema
dyspnoea on ordinary exertion
-tachycardia
-decrease in vital capacity by 1/3
-nocturnal cough
-hepatomegaly
-pleural effusion

Question 18

What investigations are required for someone with suspected cardiac failure

Answer 18

BNP
ECG
Bloods- FBC, U&Es,LFTs,TFTs,
CXR
Transthoracic echocardiography - can calculate EF

Question 19

What may someone with heart failure have on their CXR

Answer 19

Alveolar oedema
Kerley B-lines- signs of interstitial oedema
Cardiomegaly
dilated upper lobe vessels and upper lobe
effusion

Question 20

What is management for acute cardiac failure

Answer 20

ABCDE APPROACH !!

give oxygen
GTN infusion - beware can cause hypotension

IV furosemide for pulmonary oedema

CPAP- if in resp failure

Inotropic agents like DOBUTAMINE- should be considered with severe left ventricular dysfunction and cardiogenic shock

Question 21

What is the management for chronic heart failure

Answer 21

treat underlying cause , exacerbating factors, lifestyle modifications

Drugs -
first line - ACEI and beta blockers

second line - aldosterone agonist
-Spironolactone, Eplerenone, monitor potassium
SGLT 2 inhibitors

Third line ( specialist )-
Ivabradine if sinus rhythm >75/min and EF < 35%

Question 22

What vaccines should someone with right sided heart failure be given

Answer 22

annual influenza vaccine

one-off pneumococcal vaccine