Chronic Heart Failure

Question 1

What causes CHF?

Answer 1

Either

• Impaired LV contraction (Systolic HF)
• LV relaxation (diastolic HF)

Question 2

What does an impaired LV result in?

Answer 2

Chronic back-pressure of blood trying to flow into and through LHS of heart

Question 3

Presentation of CHF?

Answer 3

• Breathlessness worsened by exertion
• Cough +/- pink/white frothy sputum
• Orthopnoea
• PND
• Peripheral oedema

Question 4

What is PND?

Answer 4

Suddenly waking at night with severe SOB and cough symptoms improve over several minutes

Question 5

Causes of PND?

Answer 5

1-fluid settling across lungs large SA as they lie flat, standing up makes it go to lung base meaning upper lung can breath more effectively

2-During sleep the respiratory centre in the brain is less responsive to RR and does not increase in response to decreased oxygen sats. Allowing patient to develop more signif pulm congestion & hypoxia before waking up

3-Less adrenalin when you sleep meaning myocardium more relaxed = decreased CO

Question 6

Diagnosis of CHF?

Answer 6

Clinical presentation
BNP blood test (specifically N terminal pro-BNP)
Echocardiogram
ECG

Question 7

Causes of CHF?

Answer 7

Ischaemic heart disease
Valvular heart disease (commonly AS)
Hypertension
Arrhythmias (commonly A fib)

Question 8

1st line medical treatment for CHF?

Answer 8

A- ACEi (ramipril up to 10mg once daily)
B- Beta blocker (bisoprolol up to 10mg once daily)
A- Aldosterone antagonist when A&B nit effective
L- Loop diuretics improves symptoms

Question 9

What can you use instead of an ACEi?

Answer 9

ARB

Question 10

Management of CHF?

Answer 10

Refer to specialist
Discussion and explanation
Medical management
Surgical treatment if severe (AS/MR)