Heart Failure

Question 1

define heart failure

Answer 1

inability of the heart to pump blood sufficiently to maintain blood flow that meets the bodies requirements

Question 2

features of systolic heart failure

Answer 2

ischaemic heart disease
dilated cardiomyopathy
myocarditis
infiltration

Question 3

features of diastolic heart failure

Answer 3

hypertrophic obstructive cardiomyopathy
restrictive cardiomyopathy
cardiac tamponade
constrictive pericarditis

Question 4

clinical features of left-sided heart failure

Answer 4

shortness of breath on exertion
orthopnoea (breathing issues lying down)
paroxysmal nocturnal dyspnoea
nocturnal cough

Question 5

signs on examination in left-sided heart failure

Answer 5

tacnypnoea 
bibasal fine crackles 
cyanosis 
prolonged cap refill
hypotension

Question 6

clinical features of right-sided heart failure

Answer 6

ankle swelling
weight gain
abdominal distension
nausea

Question 7

signs on examination of right-sided heart failure

Answer 7

raised JVP
pitting ankle + sacral oedema 
hepatomegaly
ascites 
pleural effusion

Question 8

NYHA classification of heart failure

Answer 8

class I: no limitation on physical activity

class II: slight limitation on physical activity and comfort on rest

class III: marked limitation on physical activity but comfort on rest with minimal activity causing fatigue

class IV: inability to carry on physical activity and symptoms occur at rest

Question 9

investigations of heart failure

Answer 9

ECG
ECHO
bloods (FBC, U+Es, LFTs, TFTs, BNP and glucose and lipids)
CXR

Question 10

CXR findings in heart failure

Answer 10

alveolar oedema 
Kerley B lines 
cardiomegaly 
upper lobe diversion
pleural effusion
fluid in horizontal fissure

Question 11

assessment of BNP in heart failure

Answer 11

if BNP >2000 - urgent 2wk referral for ECHO

if BNP 400-2000 - 6wk referral

Question 12

lifestyle modifications in heart failure

Answer 12

smoking cessation
salt and fluid restriction
supervised cardiac rehab

Question 13

management of heart failure

Answer 13

ACE inhibitor and beta-blocker 
loop diuretic (furosemide or bumetanide)

Question 14

indications for cardiac resynchronisation therapy

Answer 14

if QRS <120 + NYHA class I-III + high risk of SCD

if QRS 120-149 + NYHA class I-III

if QRS 120-149, LBBB + NYHA class I

Question 15

initial management of acute heart failure

Answer 15

patient sat upright
oxygen therapy
IV furosemide
SC morphine