Congestive heart failure

Question 1

4 main causes of CHF

Answer 1

• IHD (40%)
• Dilated cardiomyopathy (30%)
• Valvular heart disease (10%)
• Hypertension (10%)

Question 2

Precipitants of APO

Answer 2

(MADHATTER):

• MI
• Anaemia
• Drugs/diet (high-salt, high-fluid)
• Hypertension
• Arrhythmia
• Thyrotoxicosis
• Toxic (infection)
• Endocarditis/embolism
• Renal failure

Question 3

Symptoms of LVF

Answer 3

• Exertional dyspnoea, orthopnoea, PVD
• Cough
• Fatigue

Question 4

Symptoms of RVF

Answer 4

• Ankle swelling
• Anorexia
• Nausea
• Fatigue

Question 5

Signs of LVF

Answer 5

• Bibasal crackles
• Laterally displaced apex beat
• S3 gallop
• Cyanosis
• Tachypnoea

Question 6

Signs of RVF

Answer 6

• Elevated JVP
• Peripheral oedema
• Right ventricular/parasternal heave
• Ascites
• Tender hepatomegaly

Question 7

Signs of CHF on CXR

Answer 7

(ABCDE):

• Alveolar oedema
• Kerley B lines
• Cardiomegaly
• Upper lobe diversion
• Pleural effusion

Question 8

Acute management of CHF

Answer 8

(LMNOPP):

• Lasix
• Morphine
• Nitrates
• Oxygen
• Position
• Positive airway pressure

Question 9

Chronic pharmacological management of CHF

Answer 9

• ≥I - ACEI
• ≥II - add BB
• ≥III - add spironolactone
• ≥IV - add digoxin