CCF

Question 1

What is dyspnoea?

Answer 1

Refers to a state where the subject is uncomfortably aware of his/her breathing. Associated with reduced lung compliance or increased respiratory rate.

Question 2

What are features of RHF?

Answer 2

Ascites, peripheral oedema (up to thighs, sacrum and abdominal wall), hepatomegaly, raised JVP, nausea, anorexia, facial engorgement, epistaxis

Question 3

What are features of LHF?

Answer 3

dyspnoea, PND, orthopnoea, poor exercise tolerance, fatigue, nocturnal cough, wheeze, nocturia, cold peripheries, weight loss

Question 4

What is the ‘a’ wave in the jugular venous wave

Answer 4

Right atrial contraction

Question 5

What causes the c wave in the jugular venous wave?

Answer 5

bulging of the tricuspid valve in ventricular systole

Question 6

What causes the v wave?

Answer 6

increased blood in the RA from venous return

Question 7

What is a grade 4 murmur?

Answer 7

A loud murmur with a palpable thrill.

Question 8

When should a follow-up assessment take place following discharge?

Answer 8

within 2 weeks

Question 9

What tests and imaging are used to diagnose HF? (5)

Answer 9

Blood test - FBC, haematinics, U&E, TFT, glucose, BNP, Trop-I, LFTs
ABGs
ECG
CXR
Transthoracic echo

Question 10

Why is an echo performed?

Answer 10

establish the presence or absence of cardiac abnormalities.

Question 11

How is acute HF initially managed?

Answer 11

IV diuretic therapy or IV nitrates

Question 12

When should non-invasive ventilation be offered?

Answer 12

A patient with severe dyspnoea and acidaemia

Question 13

What is the NICE definition of heart failure?

Answer 13

a complex syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump to support a physiological circulation

Question 14

What is the most common cause of HF?

Answer 14

Ischaemic heart disease

Question 15

What is systolic failure?

Answer 15

Inability of the ventricle to contract normally, resulting in reduced cardiac output. Ejection fraction (EF) is <40%.

Question 16

What is diastolic failure?

Answer 16

inability of the ventricle to relax and fill normally, causing increased filling pressures. Typically EF is >45%, this is termed HFpEF (heart failure with preserved EF).

Question 17

What are the main causes of RV failure?

Answer 17

LVF, pulmonary stenosis, lung disease

Question 18

What is acute HF?

Answer 18

new-onset acute or decompensation of chronic heart failure characterised by pulmonary and or peripheral oedema

Question 19

What is chronic HF?

Answer 19

HF that develops or progresses slowly. Venous congestion is common.

Question 20

What is the scale used for dyspnoea?

Answer 20

NYHA

Question 21

What is NYHA stage 4?

Answer 21

Symptoms at rest

Question 22

What is NYHA?

Answer 22

Marked limitation in activity due to symptoms

Question 23

What is used to diagnose CCF?

Answer 23

Framingham Diagnostic criteria. Two major or one major and two minor required.

Question 24

What are the major criteria for CCF? (7)

Answer 24

Acute pulmonary oedema, cardiomegaly, hepatojugular reflux, neck vein distension, PND or orthopnoea, rales/crackles, S3 gallop

Question 25

What are the minor criteria for ccF? (6)

Answer 25

ankle oedema, dyspnoea on exertion, hepatomegaly, nocturnal cough, pleural effusion, HR >120 bpm

Question 26

Why is an echo performed?

Answer 26

Helps define aetiology of HF. Provides information regarding the ejection fraction of the LV.

Question 27

What can be seen on CXR?

Answer 27

cardiac size, presence of oedema, pleural effusion, consolidation

Question 28

How is HF with impaired systolic function treated? (6)

Answer 28

Diuretics, ACE-I, beta-blockers, aldosterone receptor antagonists, devices: CRT/ICD

Question 29

How is HF with preserved systolic function treated?

Answer 29

diuretics, | treatment of co-morbidities

Question 30

When are Aldosterone receptor antagonists used?

Answer 30

in treatment of severe LV dysfunction (EF <35%, NYHA II)

Question 31

What does Cardiac re-synchronisation therapy (CRT) do?

Answer 31

Improves synchronicity between LV and RV and within LV

Question 32

How do Implantable cardiac defibrillators (ICD) work?

Answer 32

detect and treat ventricular arrhythmias by: - Attempting to overdrive pace VT - Deliver shock to cardiovert VT/VF

Question 33

How is acute pulmonary oedema managed? (4)

Answer 33

1) Sit patient up 2) Non-invasive positive pressure ventilation (CPAP) 3) IV GTN 4) Furosemide IV 40mg BD

Question 34

What approach is taken if patient has been in AF for longer >48hrs or unknown onset?

Answer 34

control the rate with appropriate medication and anti-coagulate the patient

Question 35

What 3 features are required to diagnose HF?

Answer 35

Symptoms - breathless, fatigue + Signs - tachycardia, raised jvp, pulmonary congestion, peripheral oedema + Objective evidence - echocardiographic evidence, S3, cardiomegaly

Question 36

What are the typical x-ray findings in CXR? (5)

Answer 36

``` alveolar shadowing kerley 'b' lines cardiomegaly dilated upper lobe vessels enlarged hilar vessels ```