Heart failure

Question 1

What does the term heart failure refer to

Answer 1

The inability of the heart to pump blood strongly enough to meet the body needs

Question 2

What can heart failure result in

Answer 2

Too little forward flow into the arterial circulation resulting in low blood pressure and poor tissue perforation

Question 3

What happens to the venous circulation in heart failure

Answer 3

Becomes congested with blood resulting in an increased capillary pressure which forces fluid from the circulation into the tissues

Question 4

What is oedema

Answer 4

Increase in extravascular fluid

Question 5

When does heart failure occur in physiological terms

Answer 5

When the heart is unable to pump sufficient blood to supply the body demand

Question 6

List some of the clinical syndrome of heart failure

Answer 6

Combination of:
1. Breathlessness
2. Oedema
3. Fatigue

Question 7

List three clinically important considerations we should make in regards to heart failure

Answer 7

1. What is the nature of the cardiac malfunction
2. What are the boys adaptive mechanism
3. What other conditions may be aggravating or precipitating the heart failure

Question 8

What can heart failure be caused by

Answer 8

Disease of the:
1. Heart muscle (myocardium)
2. The valves
3. Disturbances of the heart rhythm

Question 9

What is heart muscle dysfunction most commonly due to

Answer 9

Ischemic heart disease or hypertension

Question 10

What can cause damage to the myocardium

Answer 10

1. Drugs and alcohol
2. Nutritional deficiencies
3. Infections

Question 11

What is cardiomyopathy

Answer 11

A therm used to cover a group of heart muscle disorders of uncertain cause

Question 12

What does myocardial disease commonly result in

Answer 12

Left ventricular systolic dysfunction

Question 13

What is left ventricular systolic dysfunction

Answer 13

Weakness of the left ventricle

Question 14

What does Weakness of the left ventricle cause

Answer 14

Reduction in ejection fraction

Question 15

How much blood Is normally ejected from the ventricle with each beat?

Answer 15

More than 60%

Question 16

What does the term diastolic dysfunction refer to

Answer 16

Poor reaction of the ventricle resulting in impaired fill-in

Question 17

In whom is diastolic dysfunction more commonly seen

Answer 17

Elderly and hypertensive patients

Question 18

What happens to the myocardium in myocardial disease

Answer 18

Myocardium is less able to adapt to increasing filling pressures

Question 19

What is stenosis

Answer 19

Narrowing of a valve

Question 20

What does valve stenosis result in

Answer 20

Pressure overload of the chamber upstream of that valve

Question 21

What does aortic stenosis require

Answer 21

An increased left ventricular pressure to eject the blood and the ventricle becomes hypertrophies and can eventually fail

Question 22

What does mitral stenosis result in

Answer 22

Raised left atrial pressure resulting in dilation of the left atrium

Question 23

What does calculate regurgitation result in

Answer 23

Volume overload

Question 24

What can precipitate heart failure

Answer 24

Arrhythmias

Question 25

What can a severe tachycardia result in

Answer 25

Impairment of cardiac filling during the shortened diastole

Question 26

What can a severe bradycardia result in

Answer 26

Reduction in the number of contractions to maintain cardiac output

Question 27

Name the most common chronic arrhythmia

Answer 27

Atrial fibrillation

Question 28

What are some of the circulatory consequences of heart failure

Answer 28

1. Reduced cardiac output 2. Increased intracardiac pressure 3. Increased back pressure in venous circulation

Question 29

What can increased back pressure in the venous circulation result in

Answer 29

Increased capillary pressure and leakage of fluid into eh tissues (oedema)

Question 30

What can result in imbalance of fluids and blood pressure

Answer 30

1. Haemorrhage 2. Dehydration 3. Fluid overload

Question 31

What does reduced cardiac output result in

Answer 31

Activation of the sympathetic nervous system and the renin–angiotensin– aldosterone system

Question 32

What does the release of catecholamines adrenaline and noradrenaline stimulates

Answer 32

The force and rate of contraction of the heart Constricts the blood vessel to maintain blood pressure

Question 33

What is angiotensin

Answer 33

A vasoconstrictor

Question 34

What does aldosterone do

Answer 34

Stimulates sodium retention in the kidney and consequently water retention increasing circulatory volume

Question 35

What can sodium and water retention aggravate

Answer 35

Oedema

Question 36

What can constant stimulation of the myocardium by catechol- amines result in

Answer 36

Further myocardial damage

Question 37

Give examples of non cardiac condition that can aggravate heart failure

Answer 37

1. Anaemia and hypoxia 2. Artery venous shunts 3. Hyperthyroidism 4. Severe renal failure 5. Excessive intravenous fluid therapy

Question 38

What effect can anaemia and hypoxia have on heart failure

Answer 38

Increases cardiac workload

Question 39

What effect can Arterio-venous shunts have on heart failure

Answer 39

Require an increased cardiac output

Question 40

What effect can hyperthyroidism have on heart failure

Answer 40

Causes sympathetic stimulation and concomitant peripheral vasodilation resulting in tachycardia and high cardiac output

Question 41

What effect can severe renal failure have on heart failure

Answer 41

Impairs excretion of salt and water resulting in fluid overload

Question 42

What effect can excessive intravenous fluid therapy have on heart failure

Answer 42

Can precipitate pulmonary oedema

Question 43

What clinical features does left sided heart failure tend to cause

Answer 43

breathlessness due to pulmonary congestion

Question 44

What clinical features does right sided heart failure tend to cause

Answer 44

Systemic venous congestion with raised beaus pressure and pitting oedema

Question 45

What is the immediate first aid treatment for a patient with acute pulmonary oedema

Answer 45

1. They require hospital admission 2. Sit the patient up to optimise both the haemodynamic stress on the heart and the mechanics of breathing. 3. Oxygen should be given, and patients with ischaemic heart disease should take their GTN

Question 46

Give examples of some drugs used to manage heart failure

Answer 46

1. ACE inhibitors 2. Angiotensin 3. spironolactone in low doses 4. Beta blockers 5. Diuretics 6. Vasodilators 7. Digoxin 8. Phosphodiesterase inhibitors

Question 47

What can ACE inhibitors do

Answer 47

Reduce mortality by 25% at all levels of severity

Question 48

What can ACE inhibitors cause

Answer 48

Renal impairment and hyperkalaemia

Question 49

What do spironolactone do

Answer 49

Reduce mortality in severe heart failure patients that are already being treated with ACE inhibitors

Question 50

Give examples of Phosphodiesterase inhibitors

Answer 50

enoximone and milrinone.

Question 51

What can inhibition Phosphodiesterase cause

Answer 51

ntracellular accumulation of cAMP, which results in a rise in calcium entry. This increases the force of myocardial contraction.

Question 52

Which drugs should we be careful about giving to patients with heart failure and why

Answer 52

NSAIDs as they may cause fluid retention and acute renal failure in patients already taking diuretics and ACE inhibitors