Cardiovascular System

Question 1

What is heart failure?

Answer 1

The state in which the heart is unable to pump at a rate commensurate with the requirements of the tissues or can do so only from high pressures

Question 2

What are the two types of heart failure?

Answer 2

Systolic or diastolic

Question 3

What is systolic heart failure?

Answer 3

Less blood pumped out of ventricles, weakened heart muscle can’t squeeze as well

Question 4

What is diastolic heart failure?

Answer 4

Stiff heart can’t relax normally, less blood fills the ventricles

Question 5

What causes heart failure?

Answer 5

Coronary artery disease
Hypertension
Valvular disease
Diabetes mellitus

Question 6

What are the symptoms of heart failure?

Answer 6

Dyspnea (SOB)
Swelling 
Fatigue 
Weight gain 
Paroxysmal nocturnal dyspnea (night wakening from SOB)

Question 7

What are the pulmonary clinical findings of heart failure?

Answer 7

Respiratory distress
Crepitations
Wheeze

Question 8

What are the cardiac clinical findings of heart failure?

Answer 8

Bradycardia/tachycardia 
Displaces apex beat 
Raised JVP (jugular venous pulse)
Extra heart sounds 
Murmurs

Question 9

What are the abdominal clinical findings of heart failure?

Answer 9

Ascites (fluid collection in spaces within your abdomen)

Hepato-jugular reflux

Question 10

What are other extremities of heart failure?

Answer 10

Cool
Dependent Edelman
Cyanosis
Pallor

Question 11

What are some signs that show right sided heart failure?

Answer 11

Oedema 
Ascites
Pleural effusions
Raised JVP
Hepatomegaly

Question 12

What are some signs that show left sided heart failure?

Answer 12

Pulmonary oedema
Low BP
Fatigue

Question 13

What is pulmonary oedema?

Answer 13

Build up of excess fluid in the lungs

Question 14

What causes pulmonary oedema?

Answer 14

Increased left ventricle diastolic pressure (due to decreased amount of blood ejected during systole), raised left atrium pressures and increased pulmonary venous and capillary pressures
Once the pulmonary capillary pressure exceeds oncotic pressure fluid enters the alveoli
Respiration is stimulated via the vagus (Hering Brewer reflex)
There is also bronchial mucosa constriction causing wheeze- cardiac asthma

Question 15

What are the symptoms of pulmonary oedema?

Answer 15

Patient fighting for breath 
Rapid respiratory rate 
Distressed
Frothy pick sputum 
Crepitations and rhonchi (bubbling sound in the lungs)

Question 16

What is the NYHA classification I of heart failure?

Answer 16

No limitation of physical activity

Ordinary physical activity does not cause symptoms of HF

Question 17

What is the NYHA classification II of heart failure?

Answer 17

Comfortable at rest

Slight limitation of physical activity

Question 18

What is the NYHA functional classification III of heart failure?

Answer 18

Comfortable at rest

Marked limitation, less than ordinary activity causes discomfort

Question 19

What is the NYHA classification IV of heart failure?

Answer 19

Discomfort at rest

Question 20

What are some of the complications of HF?

Answer 20

Renal failure 
Electrolyte abnormalities 
Impaired liver function 
Thrombo-embolism 
Ventricular arrhythmias 
Sudden death

Question 21

How do you diagnose HF?

Answer 21

ECG (check for MI, PE, arrhythmia, LVH)
CXR (pulmonary venous congestion, interstitial edema, cardiomegaly, pleural effusions)
Labs- CBC, BNP, U&E, troponin, ABG, thyroid function tests
Echocardiography- evaluate severity , causes, characterisation
MRI

Question 22

What is BNP?

Answer 22

Brain natriuretic peptide
Helps to diagnose HF
If your BNP is <150 then it’s unlikely to be HF
BNP naturally increases with age, it also increases with renal disease, arrhythmia, sepsis, CAD, its also higher in women and African-Americans
It is decreased in obesity
BNP is increased in HF

Question 23

How are patients with HF managed?

Answer 23

Lifestyle modification
Vaccines 
Low sodium diet 
Alcohol and tobacco cessation 
Weight management 
Fluid management 
Treat anaemia 
Avoid NSAIDs, aspirin, thiazolidinedione (fluid retention), metformin (increased risk for lactic acidosis)

Question 24

What drugs can be used to improve the symptoms of HF?

Answer 24

Diruetics

Digoxin

Question 25

What drugs are used to improve the survival of HF?

Answer 25

Beta blockers 
Ivabradine 
ACE inhibitors 
Angiotensin receptor blockers 
Aldosterone blockers

Question 26

What is cardiac resynchronisation therapy?

Answer 26

Abnormal ventricular conduction resulting in a mechanical delay and dyssynchronous contraction
Seen in left bundle branch block

Question 27

What should be done during acute HF?

Answer 27

Oxygen 
Fluid restrictions 
Diuretics 
IV nitrates 
Inotropes