heart failure

Question 1

systolic heart failure

Answer 1

impaired contraction during systole

Question 2

diastolic heart failure

Answer 2

impaired ventricular filling during diastole

Question 3

causes of systolic HF

Answer 3

IHD
dilated cardhopmyopathy
infiltration - haemochromatosis, sarcoidosis

Question 4

causes of diastolic HF

Answer 4

hypertrophic cardiomyopathy
restrictive cardiomyopathy
cardiac tamponade
constrictive pericarditis

Question 5

high output cardiac failure

Answer 5

normal CO, but cant keep up with peripheral demand

anaemia 
AV malformation 
Paget's 
pregnancy 
thyroxicosis

Question 6

symptoms of L heart failure

Answer 6

SOB
orthopnoea
PND
cough +/- frothy sputum

Question 7

signs of L sided HF

Answer 7

tachypnoea
bibasal fine crackles
cysnosis 
prolonged CRT 
pulses alterans
S3 gallop rhythm

Question 8

symptoms of R sided heart failure

Answer 8

ankle swelling
weight gain
abdo discomfort

Question 9

signs of R sided HF

Answer 9

raised JVP
pitting oedema
ascites
transudative pleural effusions

Question 10

NYHA class I

Answer 10

no limitation physical activity

activity ≠ fatigue, SOB, palpitations

Question 11

NYHA class II

Answer 11

slight limitation
comfort at rest
ordinary activity = fatigue

Question 12

NYHA class III

Answer 12

marked limitation
comfort at rest
minimal activity = fatigue

Question 13

NYHA class IV

Answer 13

unable to carry out any activity w/o discomfort

symptoms at rest

Question 14

BNP > 2000

Answer 14

2wk wait referral

Question 15

BNP 400-2000

Answer 15

6wk wait referral

Question 16

CXR findings

Answer 16

alveolar oedema
kerley B lines
cardiomegaly 
upper lobe blood diversion 
pleural effusions 
fluid in horizontal fissure

Question 17

pharmacological Mx

Answer 17

ACE I and beta blocker

loop diuretic

Question 18

improving mortality - if cant tolerate ACEI

Answer 18

ARB

Question 19

improving mortality - if can’t tolerate ACI and ARB

Answer 19

hydralazine and silver nitrate

Question 20

Mx - symptoms persisting or class 3/4

Answer 20

aldosterone antagonist

hydralazine and nitrate if afro carribean

Question 21

when is ICD indicated

Answer 21

• QRS <120, high risk death, class 1-3
• QRS 120-149, class 1-3
• QRS 120-149, LBBB, class 1

Question 22

acute Mx pulmonary oedema

Answer 22

sit up
oxygen therapy - aim sats >94%
IV furosemide 40g

Question 23

side effects/ beta blckers

Answer 23

hypotension

bradycardia

Question 24

adverse effects/ ACEI

Answer 24

hyperkalaemia

dry cough

Question 25

adverse effects/ spironolactone

Answer 25

hyperkalaemia

gynaecomastia

Question 26

adverse effects/ furosemide

Answer 26

hyponatraemia

hypokalaemia