Cardiac failure

Question 1

Cardiac failure?

Answer 1

Inability of the cardiac output to meet the body’s demands despite normal venous pressures

Question 2

Cardiac failure causes: low output cardiac failure left heart (5)?

Answer 2

IHD, hypertension, cardiomyopathy, aortic valve disease, mitral regurgitation

Question 3

Cardiac failure causes: low output cardiac failure right heart (7)?

Answer 3

secondary to left heart failure, infarction, cardiomyopathy, pulmonary hypertension/embolus/valve disease, chronic lung disease, tricuspid regurgitation, constrictive pericarditis

Question 4

Cardiac failure causes low output cardiac failure biventricular (4)?

Answer 4

arrhythmia, cardiomyopathy, myocarditits, drug toxicity.

Question 5

Cardiac failure causes high output cardiac failure (5)?

Answer 5

(increased demand) anaemia, beri beri, pregnancy, pagets disease, hyperthyroidism.

Question 6

Cardiac failure left heart failure symptoms (3)?

Answer 6

symptoms caused by pulmonary congestion (dyspnoea, paroxysmal nocturnal dyspnoea, fatigue).

Question 7

Cardiac failure acute left ventricular failure symptoms(4)?

Answer 7

dyspnoea, wheeze, cough, pink frothy sputum

Question 8

Cardiac failure right heart failure (6) symptoms?

Answer 8

swollen ankles, fatigue, increased weight due to oedema, reduced exercise tolerance, anorexia, nausea

Question 9

Cardiac failure signs left heart failure (6)?

Answer 9

tachycardia, tachypnoea, displaced apex beat, bilateral basal crackles, S3 gallop, pansystolic murmur.

Question 10

Cardiac failure signs acute left ventricular failure (8)?

Answer 10

tachypnoea, cyanosis, tachycardia, peripheral shutdown, pulsus alternans, gallop rhythm, wheeze, fine crackles

Question 11

Cardiac failure signs right heart failure (4)?

Answer 11

raised JVP, hepatomegaly, ascites, ankle/sacral pitting, signs of functional tricuspid regurgitation

Question 12

Cardiac failure what is pulsus alternans?

Answer 12

arterial pulse waveforms showing alternating strong and weak beats, a sign of left ventricular systolic impairment, this is explained by decreased ejection fraction leading to reduced stroke volume, causing an increase in end-diasolic volume meaning the left ventricle is stretched more for the next contraction and this causes an increase in the strength of the myocardial contraction

Question 13

Cardiac failure investigations bloods?

Answer 13

FBC, U&Es, LFTs, CRP, Glucose, Lipids, TFTs, ABG, Troponin and BNP (raised BNP is diagnosis)

Question 14

Cardiac failure investigations CXR?

Answer 14

shows alveolar shadowing, Kerley B lines, cardiomegaly, upper lobe diversion, pleural effusion.

Question 15

Cardiac failure investigations ECG?

Answer 15

may show ischaemic changes or arrhythmia or left ventricular hypertrophy

Question 16

Cardiac failure management acute left ventricular failure?

Answer 16

treat cardiogenic shock (severe cardiac failure with low BP, use inotropes in ITU) treat pulmonary oedema with O2 diamorphine GTN infusion, IV furosemide.

Question 17

Cardiac failure management chronic left ventricular failure?

Answer 17

treat cause (hypertension) treat exacerbating factors (anaemia) give ACE inhibitors, beta blockers, loop diuretics, aldersterone antagonists, angiotensin receptor blockers, hydralazine and a nitrate, digoxin, N-3 polyunsaturated fatty acids.

Question 18

Cardiac failure complications?

Answer 18

Resp failure, cardiogenic shock, death