Cardiovascular: Left Ventricular Failure

Question 1

what is left ventricular failure caused by?

Answer 1

• systolic impairment (pumping mechanism)

- long standing hypertension

Question 2

what is left ventricular failure?

Answer 2

• pressure increases in systemic circulation (hypertension)
• left sided hypertrophy (harder to push blood out)
• more demand for o2 but reduced supply

Question 3

why do you get oedema with left ventricular failure?

Answer 3

When there is left sided cardiac failure, less blood gets pumped to the kidneys which activates the RAAS system, which causes fluid retention (oedema).

Question 4

why do you get SOB with left ventricular failure?

Answer 4

• backlog of blood in LA, pulmonary veins and lungs
• vessels begin to leak (pulmonary oedema)
• interferes with gas exchange causing SOB
• Left ventricular failure causes a type 1 respiratory failure (low O2 without an increase in CO2).

Question 5

what are some risk factors for left ventricular failure?

Answer 5

Hypertension. 
MI.
Arrhythmias (AF).
Valvular heart disease (aortic stenosis). 
Ischaemic heart disease. 
Dilated cardiomyopathy. 
Smoking.
Diabetes. 
Hypercholesterolemia.

Question 6

what is the prognosis of heart failure?

Answer 6

50% of people with heart failure die within 5 years.

Question 7

what signs on examination may you find for left ventricular failure?

Answer 7

Low cardiac output / hypoperfusion of tissues / Inc resp rate / reduced O2 sats / 3rd heart sound / crackles on auscultation.

Question 8

what are some clinical features of left ventricular failure?

Answer 8

• rapid onset dyspnoea – Exacerbated when lying flat and improves on sitting up.
• orthopnoea
• Paroxysmal nocturnal dyspnoea
• cyanosis
• breathlessness worsened on exertion

Question 9

what is dyspnoea?

Answer 9

difficult or laboured breathing (SOB)

Question 10

what is orthopnoea?

Answer 10

SOB when lying flat

Question 11

what is Paroxysmal nocturnal dyspnoea?

Answer 11

Patients wake suddenly at night with a severe attack of SOB and cough. The feel like they are suffocating.

Question 12

which conditions present in a similar way to left ventricular failure?

Answer 12

Acute coronary syndrome.
Aortic dissection.
Arrhythmia.
Aortic stenosis.
Endocarditis.
COPD.
Pneumonia. 
Acute respiratory distress syndrome.
Renal failure.

Question 13

what investigations would you conduct to confirm a diagnosis of left ventricular failure?

Answer 13

• BNP blood test
• echocardiogram

other investigations to consider: ECG, CXR, ABG, FBC etc.

Question 14

what is the treatment for left ventricular failure?

Answer 14

“POUR SOD”

• Pour (away); Stop IV fluids.
• Sit patient up.
• Oxygen.
• Diuretics (IV furosemide)

Question 15

if a patient is admitted to hospital with left ventricular failure what should you monitor?

Answer 15

Monitor the fluid intake, urine output, U&E’s and daily body weight – it is essential to balance fluid input + output.