Chronic Heart F

Question 1

Features

Answer 1

Pulmonary oedema: dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea
Poor renal perfusion–> oliguria and uraemia
Low CO- cool peripheries, hypotensiom
Wt loss - cardiac cachexia
Arrythmias- sudeen death due to V Fib _ 50% of patients.

Question 2

What is the blood test to exclude CHF?

Answer 2

BNp- Serum marker for imparied LVF rarely raised in individuals with normal cardiac Fx.secreted from ventricles in respone to fluid overload- to reduce vascular resistance and cardiac preload while promoting natriuresis (large amounts of Na excreted in urine) .

BNP alongside ECG
Diagnostic value + prognostic- the higher the value the more sveere the disease.

Other useful: FBC, U+E, TFTs, CxR.

Question 3

What do we do in the presence of CHF features? Either raised BnP or ecg changes

Answer 3

Transthoracic Doopler echo.

If not conclusive: tranoesophageal, MRi.

Question 4

What do we use as a first line tx of CHF and helpd remodel the heart?

Answer 4

ACE Is - + low salt diet and exercise , stop smoke, reduce alcohol.

Question 5

Causes

Answer 5

LHF- IHD, HTn, valvular disease and high output states: anaemia, thyrotoxicosis.

RHf- LHF and chronic lung disease eg cor pulmonale

Question 6

1 line diuretics used??

Answer 6

Loop diuretics- furosemide, butenamide- inhibit Na + CL reabsorbption in ascending loop of henle- sx relief of HF

SE: hypokalaemia, hyponatraemia, hypotension.
If not worked with high dose–> THIAZIDE added.

Thiazides inhibit Na and CL reabs in DCT: SE: Hypokalaemia, hyperuricaemia (near urine collection) –> GOUT precipitation.

Question 7

Why is spironolactone used?

Answer 7

Aldosterone antagonist
Increased Na secretions
Reduced K secretion so does not cause hypokalaemia like loops and thiazisdes–> K sparing.

Amilodarone also. Indicated in severe sx disease.
Improves sx and mortality.
Check serum K before and after
- to detect hyperkalaemia.

SE: hyponatraemia, gynaecomastia, menstrual disturbance.

Question 8

When are b blockers added?

Answer 8

Atenolol,
Counteract sympathetic stimulation. Ie REDUCE AFTERLOAD (symp- vasoconstriction)

1. Decrease hospitalisation
2. Improve mortality in HF

Question 9

When is digoxin added?

Answer 9

To manage HF in patients with AF.