Chronic Heart Failure

Question 1

Mechanism of heart failure

Answer 1

Impaired left ventricular contraction or left ventricular relaxation. Causes chronic back pressure of blood trying to flow

Question 2

Presentation of chronic heart failure

Answer 2

breathlessness worsened by exertion, cough, orthopnoea, parapxysmal nocturnal dysopnoea, peripheral oedema

Question 3

Diagnosis of chronic HF

Answer 3

Clinical presentation, BNP blood test, echo, ECG

Question 4

Causes of chronic HF

Answer 4

Ischaemic heart disease, valvular heart disease, hypertension, arrhythmias (commonly AF)

Question 5

Management of HF

Answer 5

Refer to specialist, careful discussion and explanation, medical management, surgical treatment, HF specialist nurse

Question 6

Medical management of chronic HF

Answer 6

ACEI, Bete blocker, Aldosterone antagonist if not controlled, loop diuretics to improve symptoms

Question 7

Eg of ACEI used in HF

Answer 7

Ramipril up to 10mg daily

Question 8

Eg of beta blocker used in HF

Answer 8

Bisoprolol up to 10mg daily

Question 9

Eg of aldosterone antagonist used

Answer 9

Spironolactone or eplerenone

Question 10

Eg of loop diuretic used in HF

Answer 10

Furosemide up to 40mg

Question 11

What is an option if ACEIs are not tolerated

Answer 11

ARBs such as candesartan

Question 12

What needs to be monitored due to medication

Answer 12

U&Es as diuretics, ACEI and aldosterone antagonists can cause electrolyte disturbances

Question 13

When would you add an aldosterone antagonist

Answer 13

When there is reduce ejection fraction and symptoms are not controlled with ACEI and BB

Question 14

What is right sided heart failure

Answer 14

Cor pulmonale

Question 15

What is the disease process of right sided heart failure

Answer 15

Caused by respiratory disease where the increased pressure and resistancein the pulmonary arteries results in the right ventricle being unable to effectively pump blood out, causing back pressure in right atrium and systemic venous system

Question 16

What is the disease process of right sided heart failure

Answer 16

Caused by respiratory disease where the increased pressure and resistancein the pulmonary arteries results in the right ventricle being unable to effectively pump blood out, causing back pressure in right atrium and systemic venous system

Question 17

Respiratory causes of right sided heart failure

Answer 17

COPD (most common), PE, interstitial lung disease, cystic fibrosis, primary pulmonary hypertension

Question 18

Presentation of right sided heart failure

Answer 18

SOB, peripheral oedema, breathlessness on exertion,syncope and chest pain. Can be asymptomatic

Question 19

Examination signs of cor pulmonale

Answer 19

Hypoxia, cyanosis, raised JVP, peripheral oedema, third heart sound, murmurs, hepatomegaly

Question 20

Management of cor pulmonale

Answer 20

Treating symptoms and underlying cause, LTOT.

Question 21

ECG findings of heart failure

Answer 21

Tachycardia, AF, left axis deviation, P wave changes, wide QRS, prolonged PR interval - can be normal or identify cause

Question 22

ECHO of heart failure

Answer 22

<40% = reduced ejection fraction
<40% but raised BNP = preserved ejection fraction

Question 23

CXR findings in heart failure (ABCDEF)

Answer 23

Alveolar oedema
Kerley B lines
Cardiomegaly
Dilated upper lobe vessels
Effusions
Fluid in horizontal fissure