Heart Failure

Question 1

Decompensated HF is the term used to describe sudden worsening of HF. What are the most common causes?

Answer 1

1.

• ACS
• hypertensive crisis
• acute arrhythmia
• valvular disease

Question 2

Heart Failure Clinical Features

1. For acute HF, what are the
   a) symptoms
   b) signs
2. What additional clinical features can be seen in chronic HF?
3. What clinical features are associated with right HF?

Answer 2

1. a)
   - breathlessness
   - reduced exercise tolerance
   - oedema
   - fatigue

b)
- cyanosis
- bibasal crackles (could also be wheeze)
- tachycardia
- raised JVP
- displaced apex beat
- S3

2. • orthopnoea / paroxysmal nocturnal dyspnoea
   • cough: associated with pink frothy sputum and worse at night

3.

• raised JVP
• hepatomegaly
• ankle oedema

mnemonic: work back from RA

Question 3

Heart Failure: acute management

1. What should be given to:
   a) all patients
   b) patients with resp. failure
2. What should be considered in patients:
   a) with myocardial ischameia, severe hypertension or left valve disease?
   b) severe LV dysfunction / cariogenic shock
3. When would beta blockers be discontinued?

Answer 3

1. a) IV loop diuretic (furosemide or bumetanide)

b) CPAP

2. a) nitrates
   b) intotropes e.g. dobutamine
3. • bradycardia (<50bpm)
   • 2nd or 3rd degree heart block
   • shock

Question 4

What is meant by

1. heart failure
2. ejection fraction
3. preload
4. afterload

Answer 4

1. inability to pump enough blood to match the metabolic demands of the body
2. percentage of blood in the left ventricle which is pumped out following a contraction
3. stretching of muscle prior to contraction

NOTE: e.g. aortic regurgitation

4. force heart must contract against to eject blood

NOTE: e.g. aortic stenosis or hypertension

Question 5

What are the possible causes of

1. systolic dysfunction
2. diastolic dysfunction
3. high-output HF

Answer 5

1. • ischaemic heart disease
   • dilated cardiomyopathy
   • arrhythmia
2. • hypertrophic cardiomyopathy
   • restrictive cardiomyopathy
   • cardiac tamponade
   • restrictive pericarditis
3. • thyrotoxicosis
   • thiamine deficiency
   • arterio-venous malformation
   • anaemia
   • pregnancy
   • Paget’s disease

mnemonic: the TTAAPP (I.e. heart pumping the blood) is working fine