heart failure

Question 1

symptoms of heart failure

Answer 1

shortness of breath 
wheezing and coughing
ankle swelling
reduced exercise tolerance 
fatigue

Question 2

reduced vs preserved ejection fraction

Answer 2

reduced - left ventricle loses ability to contract normally 40% reduction in ejection fraction
perseved - loses ability to relax - EF normal or mildly reduced

Question 3

signs of heart failure

Answer 3

elevated venous jugular pressure, pulmonary crackles and pulmonary oedema

Question 4

aims of heart failure treatment

Answer 4

reduce mortality
reduce symptoms
increase exercise tolerance

Question 5

daily weighing

Answer 5

an increase of 1.5kg - 2.0kg in 2 days should be reported to heart failure specialist

Question 6

salt and fluid intake advice

Answer 6

only restrict if these are high
salt intake of less than 6g a day
avoid salt substitutes containing potassium

Question 7

salt and fluid intake advice

Answer 7

only restrict if these are high
salt intake of less than 6g a day
avoid salt substitutes containing potassium - reduce risk of hyper

Question 8

What is diluteinal hyponatremia and how is it managed

Answer 8

the bodies consumption of water exceeds the kidneys ability to eliminate water- only limit water intake

Question 9

drug treatment

Answer 9

ace inhibitor and beta blocker
OR hydralazine and nitrate and beta blocker to reduce mortality
ARB can be used in place of ACE
diuretics
clinical judgement used to decide which to start first and second drug only started when 1st drug is stable

aldosterone antagonist e.g. epelerone or spiralactone

Question 10

what drugs should be avoided in patients with reduced EF

Answer 10

rate limiting CCBs, short acting dihyropryridines as they reduce cardiac contractility

Question 11

what is the advice on use of thiazide diuretics in HF

Answer 11

only of benefit for patients with mild fluid retention and eGFR od greater than 30ml/min/1.73m2

Question 12

when can anticoagulation be considered

Answer 12

patients in sinus rhythm with a
history of vte
left ventricular anaersym
inter cardiac thrombus

Question 13

monitoring of ACE/ARB and beta blockers

Answer 13

ACE - ARBs, aldosterone antagonists serum potassium 1/2 weeks after starting and at each dose increment
then every 3 months, then 6 months and if acutely unwell

BB - heart rate, blood pressure, symptom control at start

Question 14

How is management of HF adjusted in CKD

Answer 14

lower dose ACE ARB, aldosterone antagonist and digoxin