Cardiovascular Workshop Cases

Question 1

How does raised JVP indicate heart failure?

Answer 1

Pressure and fluid backs up from heart, which causes jugular vein (branches of subclavian veins) to be raised

Question 2

How does ankle oedema indicate heart failure?

Answer 2

Pressure and fluid backs up from heart and gravity causes fluid to accumulate in ankles

Question 3

What does orthopnoea indicate?

Answer 3

Pulmonary oedema due to fluid pressing on the lungs when in the supine position

Question 4

Give the main risk factors for heart failure.

Answer 4

. Hypertension because it can cause left ventricular hypertrophy (due to the blood quickly returning to the heart and the heart having to pump it out again at a fast rate), then left ventricular hypertrophy can go on to cause right ventricular hypertrophy
. Ischaemic heart disease (clogged coronary arteries)
. Cardiac arrhythmias

Question 5

What type of heart failure does pulmonary oedema indicate?

Answer 5

Left ventricular failure (blood draining into left ventricle from lungs backs up, causing backing up of fluid)

Question 6

What does peripheral oedema indicate?

Answer 6

Right ventricular failure (Blood draining into right ventricle from whole body backs up, causing backing up of fluid)

Question 7

Which tests are used to diagnose heart failure? Give one cheaper alternative.

Answer 7

. ECG (shows heart rate and rhythm) and chest x-ray (can show hypertrophic heart and pulmonary oedema)
. Cheaper alternative for ECG is B-natriuretic peptide test

Question 8

How can B-natriuretic peptide indicate heart failure?

Answer 8

BNP is a hormone released by cardiomyocytes when the cardiac hypertrophy/ heart is stretched due to increased blood volume

Question 9

What is one key risk of using diuretics that needs to be closely monitored?

Answer 9

Patient can become hypokalaemic (low potassium) due to losing fluid and potassium via kidneys