Chronic Heart Failure

Question 1

What is the presentation of chronic HF?

Answer 1

SOB worsened by exertion 
Cough and maybe frothy white/pink sputum
Orthopnoea (ask how many pillows they use)
Paroxysmal nocturnal dyspnoea
Peripheral oedema

Question 2

What are the initial investigations for chronic HF?

Answer 2

History 
Examination 
N-Terminal pro-B-type natriuretic peptide (NT-proBNP)
Echo
ECG

Question 3

What are the causes of chronic HF?

Answer 3

Ischaemic heart disease
Valvular heart disease (commonly aortic stenosis)
Hypertension
Arrhythmias (commonly Afib)

Question 4

What are the next steps after someone is diagnosed with chronic HF?

Answer 4

Refer to specialist

Careful discussion and explanation of condition

Medical management (see flash card on this)

Surgical treatment in severe aortic stenosis or mitral regurgitation

Heart failure specialist nurse input

Question 5

What lifestyle management should people with chronic HF have?

Answer 5

Stop smoking
Optimise treatment for comorbidities
Exercise as tolerated

Question 6

What yearly vaccine should people with chronic HF be advised to have?

Answer 6

Pneumococcal

Question 7

What is the first line medical treatments for chronic HF?

Answer 7

ABAL

A- ACE inhibitor
B- Beta Blocker
A- Aldosterone antagonist when symptoms not controlled with A and B (spironolactone or eplerenone)
L- Loop diuretic (furosemide)

Question 8

What blood test should all patients on diuretics, ACE inhibitors and almost antagonists have?

Answer 8

U+E

All 3 meds cause electrolyte disturbances