Chronic heart failure

Question 1

How does chronic heart failure present?

Answer 1

breathlessness worsened by exertion
cough - may be frothy white / pink sputum
Orthopnea
paroxysmal nocturnal dyspnoea
peripheral oedema

Question 2

What is paroxysmal nocturnal dyspnoea?

Answer 2

the experience patients have of suddenly waking at night with a severe attaack of shortness of breath and cough

Question 3

How is chronic heart failure diagnosed?

Answer 3

clinical presentation
BNP test
echo
ECH

Question 4

What are the causes of chronic heart failure?

Answer 4

ischaemic heart disease
valvular heart disease (aortic stenosis)
hypertension
arrhythmias (AF)

Question 5

What is the management of heart failure?

Answer 5

Refer to specialist
Careful discussion and explaination 
medical management 
surgical treatment for severe valvular disease
heart failure specialist nurse

Question 6

What is the additional management for HF?

Answer 6

yearly flue and pneumococcal vaccine
stop smoking
optimise treatment of co-morbidities
Exercise as tolerated

Question 7

What is the first line medical management of heart failure?

Answer 7

ACE inhibitor
Beta blocker
Aldosterone antagonist is symptoms are not controlled with A and B
Loop diuretics to improve symptoms

Question 8

Name and dose of ACEI?

Answer 8

Ramipril as tolerated up to 10mg/day

Question 9

Name and dose of beta blocker

Answer 9

bisoprolol as tolerated up to 10mg/day

Question 10

Give examples of aldosterone antagonists

Answer 10

sprionalactone

eplerenone

Question 11

Name and dose of loop diuertic

Answer 11

furosemide 40mg/day

Question 12

Give an example of an angiotensin receptor blocker

Answer 12

candesartan

Question 13

In which patients should ACEI be avoided?

Answer 13

Patients with valvular disease

Question 14

When are aldosterone antagonists used?

Answer 14

when there is a reduced ejection fraction and symptoms are not controlled with an ACEi and beta blocker