Heart Failure

Question 1

How does heart failure most commonly arise?

Answer 1

When cardiac output is low (many causes), body thinks fluid is low and so retains fluid, causing fluid overload, thus the heart has to work harder (and often can’t)

Question 2

What are the main causes of left sided heart failure?

Answer 2

Ischaemic heart disease (MI etc.)
Cardiomyopathies
Valvular disease

Question 3

How do numerous MIs lead to heart failure?

Answer 3

Scar tissue is left resulting in reduced contractility, so cardiac output decreases

Question 4

What are the main causes of right sided heart failure?

Answer 4

Secondary to left heart failure
Cor pulmonale
Congenital defects

Question 5

How does cor pulmonale cause heart failure?

Answer 5

Lung disease causes hypoxia, resulting in pulmonary vasoconstriction, causing increased back pressure, so right heart has to work harder and often fails

Question 6

What are the main symptoms of left heart failure?

Answer 6

Dyspnoea on exertion/rest
Orthopnoea
PND
Pink, frothy sputum (pulmonary oedema)

Question 7

What are the main signs of left heart failure?`

Answer 7

Tachycardia
Crepitations
Pleural effusion
S3
Cardiomegaly, bats wings on CXR

Question 8

What are the main symptoms and signs of right heart failure?

Answer 8

Ankle swelling
Raised JVP
Hepatomegaly
Ascites

Question 9

What are the main drugs used for heart failure?

Answer 9

ABAL:

ACEi
B blockers
Aldosterone antagonist- Spironolactone
Loop diuretics

Question 10

What invasive therapy can be used to treat heart failure?

Answer 10

Implantable defibrilators
Cardiac resynch therapy

Question 11

What does cardiac resynch therapy achieve?

Answer 11

If both sides of heart contracting at different times (slight delay), CRT minimises this gap to improve cardiac efficiency

Question 12

What is the unwanted effect of furosemide?

Answer 12

Hypokalaemia

Question 13

How might hypokalaemia be corrected in heart failure treatment?

Answer 13

Use furosemide in conj with ACEi/spironolactone - these cause hyperkalaemia

Question 14

What type of drug is spironolactone?

Answer 14

Aldosterone antagonist

Question 15

How does left ventricular failure cause pulmonary oedema?

Answer 15

LV failure cause LA pressure to rise, causing back pressure on the lungs which increases pulmonary capillary hydrostatic pressure, causing fluid to accumulate in the pleural space