Congestive Cardiac Failure

Question 1

What is it?

Answer 1

Failure of the heart to work effectively as a pump

Can be due to impaired ventricular contraction (systolic) or impaired ventricular relaxation (diastolic)

Question 2

What is the difference between systolic and diastolic heart failure?

Answer 2

Diastolic- failure of the heart to fill properly
Systolic- inability to pump blood effectively

Question 3

What are the symptoms of left side CCF?

Answer 3

Dyspnoea
Orthopnoea
Paroxysmal nocturnal dyspnoea
Cough- frothy white/pink sputum
Fatigue

Question 4

What are the symptoms of right side CCF?

Answer 4

Fatigue
Anorexia
Ankle swelling
Dyspnoea

Question 5

What are the signs of left side CCF?

Answer 5

Cardiomegaly
Displaced apex beat
Bilateral crackles
3rd HS
-gallop rhythm if tachycardic

Question 6

What are the signs of right side CCF?

Answer 6

Ascites
Hepatomegaly
Pitting oedema 
Raised JVP
3rd heart sound
-gallop rhythm 
Cardiomegaly

Question 7

What investigations are needed?

Answer 7

BP
ECG
Blood
-FBC
-U&Es
-LFTs
-BNP
-TFTs

CXR

• cardiomegaly
• pulmonary oedema

ECHO= gold standard
-ejection fraction <45%= diagnostic

Question 8

What is the management?

Answer 8

Conservative

• patient education
• refer to cardio
• exercise
• weight loss
• control co morbidities

Medical

1) ACEi and beta blocker
- start on one and then add other in
- low dose and titrate up as can worsen symptoms
- ACEi can cause hyperkalaemia
2) aldosterone antagonist
- if symptoms are not controlled by 1
- can also cause hyperkalaemia so monitor

Furosemide can help with symptoms but does not decrease mortality

Monitor U&Es

Question 9

What is the classification system for heart failure?

Answer 9

NYHA

Question 10

What is NYHA class 1

Answer 10

No symptoms. Able to complete ordinary physical exercise with no fatigue, dyspnoea or palpitations

Question 11

What is NYHA Class 2

Answer 11

Mild symptoms of dyspnoea, fatigue or palpitations when completing ordinary activities. No symptoms at rest

Question 12

What is NYHA Class 3

Answer 12

Marked reduction in physical activity. Less than ordinary activities cause symptoms. No symptoms at rest

Question 13

What is NYHA class 4?

Answer 13

Symptoms at rest

Question 14

What are causes of right sided heart failure?

Answer 14

ASD
VSD
Chronic lung disease

Question 15

What are causes of left sided heart failure?

Answer 15

SYSTOLIC
IHD
Dilated Cardiomyopathy
Long standing hypertension

DIASTOLIC
Hypertension
Aortic stenosis
Restrictive cardiomyopathy