Chronic Heart Failure

Question 1

What causes chronic heart failure?

Answer 1

• impaired left ventricular contraction
• left ventricular relaxation
• leads to chronic back- pressure of blood flowing to left part of the heart

Question 2

How does chronic heart failure present?

Answer 2

Breathlessness worsened by exertion
Cough. They may produce frothy white/pink sputum.
Orthopnoea
Paroxysmal Nocturnal Dyspnoea
Peripheral oedema

Question 3

What is Paroxysmal Nocturnal Dyspnoea ?

Answer 3

• when patients suddenly wake at night with severe shortness of breath and cough

Question 4

How is Paroxysmal Nocturnal Dyspnoea caused ?

Answer 4

• fluid settles across a large surface of lungs when lying flat
• resp centre in the brain becomes less responsive -> more pulmonary congestion and hypoxia
  -less adrenalin in sleep which means myocardium more relaxed and less cardiac output

Question 5

How do we diagnose CHF?

Answer 5

Clinical presentation
BNP blood test (specifically “N-terminal pro-B-type natriuretic peptide” – NT‑proBNP)
Echocardiogram
ECG

Question 6

What are the causes of CHF?

Answer 6

Ischaemic Heart Disease
Valvular Heart Disease (commonly aortic stenosis)
Hypertension
Arrhythmias (commonly atrial fibrillation)

Question 7

How do we manage CHF?

Answer 7

-Refer to specialist (NT-proBNP > 2,000 ng/litre warrants urgent referral)
-Careful discussion and explanation of the condition
-Medical management (see below)
-Surgical treatment in severe aortic stenosis or mitral regurgitation
-Heart failure specialist nurse input for advice and support

Question 8

What is the first line medical treatment for CHF (ABAL) ?

Answer 8

-ACE inhibitor (e.g. ramipril titrated as tolerated up to 10mg once daily)
-Beta Blocker (e.g. bisoprolol titrated as tolerated up to 10mg once daily)
-Aldosterone antagonist when symptoms not controlled with A and B (spironolactone or eplerenone)
-Loop diuretics improves symptoms (e.g. furosemide 40mg once daily)