Chronic Heart Failure

Question 1

What chamber of the heart is chronic heart failure linked to?

Answer 1

left ventricle

Question 2

What causes chronic heart failure?

Answer 2

ischaemic heart disease
valvular heart disease
hypertension
arrhythmias (AF)
cardiomyopathy

Question 3

What are the key symptoms of chronic heart failure?

Answer 3

breathlessness worsened by exertion
cough with frothy white pink sputum
orthopnoea (breathlessness when lying flat)
paroxysmal nocturnal dyspnoea (sudden feeling of waking at night with severe attack of coughing and SOB)
peripheral oedema
fatigue

Question 4

What examination findings would there be in chronic heart failure?

Answer 4

raised heart rate and respiratory rate
hypertension
murmurs
3rd heart sound on auscultation
bilateral basal crackles on auscultation - pulmonary oedema
raised JVP
peripheral oedema

Question 5

How is chronic heart failure diagnosed?

Answer 5

clinical findings
B-type naturitic peptide blood test
ECG
echocardiogram

Question 6

How do you decide who needs an urgent referral to a heart specialist?

Answer 6

B-type naturitic peptide levels
>2000= 2 week referral
400-2000= 6 week referral

Question 7

What is the first line medical treatment plan for chronic heart failure?

Answer 7

ACE inhibitor (ramipril)
beta blocker (bisoprolol)
loop diuretics (furosemide or bumetanide)
+ aldosterone antagonist when not controlled by ACE and beta

Question 8

What electrolyte abnormality commonly occurs and therefore needs to be monitored while being treated for chronic heart failure?

Answer 8

hyperkalaemia

Question 9

What is the strongest prognostic indicator of chronic heart failure?

Answer 9

left ventricular ejection fraction