Chronic Heart Failure

Question 1

What is Chronic Heart Failure

Answer 1

Condition where heart is unable to pump blood through the body.

Question 2

What are the two types of Chronic Heart Failure

Answer 2

1- Left ventricular relaxation ( diastolic heart failure )

2- impaired left ventricular contraction ( systolic heart failure )

Question 3

How does impaired left ventricular function cause heart failure

Answer 3

Results in chronic back pressure of blood trying to flow into/through left side of heart

Question 4

How would a patient with chronic heart failure present ( Hint : 5)

Answer 4

1- Breathlessness ( worsened by exertion ) 
2- Cough ( frothy/white sputum ) 
3- Orthopnoea 
4- Paroxysmal Nocturnal Dyspnoea
5- Peripheral oedema

Question 5

What is PND

Answer 5

Paroxysmal nocturnal dyspnoea. When a person wakes up at night with severe attack of SOB and cough. Person feels as they are suffocating but symptoms improve over a several minutes.

Question 6

List possible causes of PND

Answer 6

1- Fluid settling across large SA of lung while asleep
2- Since the respiratory centre in brain is less responsive during sleep respiratory rate is not increased if there is reduced oxygen saturation. Person can develop hypoxia and pulmonary congestion before waking up.
3- Less adrenalin circulates during sleep which results in a relaxed myocardium and less cardiac output.

Question 7

What investigations are done for a patient who presents with chronic heart failure

Answer 7

1- Clinical presentation of patient
2- BNP blood test
3- Echocardiogram
4- ECG

Question 8

List the causes of Chronic Heart Failure

Answer 8

1- Ischaemic Heart Disease
2- Valvular Heart Disease ( aortic stenosis )
3- Hypertension
4- Arrhythmias ( atrial fibrillation )

Question 9

What is the Management guidelines for chronic heart failure ( Hint : 9 )

Answer 9

1- Refer to specialist 
2- discuss and explain condition 
3- medical management 
4- surgical treatment
5- Heart failure specialist nurse 
6- Yearly flu and pneumococcal vaccine 
7- Stop smoking 
8- optimize treatment of co- morbidities 
9- exercise

Question 10

What is the first line medical treatment for chronic heart failure ( be specific with dosage, reasons and drug names )

Answer 10

A : ACE inhibitor ( rampipril up to 10 mg a day)
B : Beta blocker ( bisoprolol up to 10 mg a day )
A : Aldosterone antagonist when symptoms are not controlled with A or B and there is a reduced ejection fraction ( Spironolactone / elperenone)
L : Loop diuretics to improve symptoms ( furosemide 40 mg a day )

Question 11

What can be used for CHF if an ACE inhibitor is not tolerated

Answer 11

Angiotensin Receptor Blocker ( ex: candesartan )

Question 12

When should ACE inhibitors be avoided

Answer 12

Avoided with patients with valvular heart disease

Question 13

What should be monitored while patient is on First line medications for CHF and why

Answer 13

U&E since the medications can cause electrolyte disturbance.