heart failure

Question 1

what HTN drug can you not use in HF

Answer 1

CCB

Question 2

Ix: NT-proBNP for heart failure
>2000ng/L ⇒ ?

Answer 2

Urgent 2WW + ECHO

Question 3

BNP 400-2000ng/L

Answer 3

6WW + ECHO

Question 4

on ECHO if EF <40%

Answer 4

HFrEF

Question 5

if on echo EF >40% + Raised BNP ⇒ ?

Answer 5

HFpEF

Question 6

heart fialure CXR ABCDEF

Answer 6

Alveolar oedema (“batwing” appearance shadowing)
Kerley B lines (caused by interstitial oedema)
Cardiomegaly
Upper lobe blood Diversion
Pleural Effusions
Fluid in horizontal fissure

Question 7

acute HF treatment

Answer 7

Acute decompensated ⇒ IV furosemide 50mg BD + Oxygen

1. ACE inhibitor (e.g. ramipril)
2. Aldosterone antagonist (e.g. spironolactone or eplerenone)
3. Ivabradine, sacubitril-valsartan, hydralazine in combination with nitrate, digoxin and cardiac resynchronisation therapy

Question 8

chronic HF treatment

Answer 8

Tx: ABAL + Annual influenza vaccination
ACE inhibitor (e.g. ramipril)
Beta blocker (e.g. bisoprolol)
Aldosterone antagonist when symptoms not controlled with A and B (e.g. spironolactone or eplerenone)
Loop diuretics (e.g. furosemide)

Question 9

what is ivabradine

Answer 9

is a funny channel inhibitor which acts to slow ionic depolarisation through the pacemaker cells and therefore slow heart rate allowing for more filling time. It is used as a 4th line medication for those with an impaired LV systolic function and a higher heart rate prior to considering device therapy.

Question 10

what is cor pulmonale

Answer 10

Right sided heart failure caused by respiratory disease
↑ Pressure & Resistance in pulmonary arteries ⇒ Pulmonary HTN ⇒ RV unable to pump blood out effectively into pulmonary arteries ⇒ Back pressure of blood in RA, VC and systemic venous system

in COPD
PE
CF
priamry pumonayr HTV

Question 11

sx

Answer 11

Early cor pulmonale ⇒ Asymptomatic
Peripheral oedema
Raised JBP
Hepatomegaly
SoB (due to underlying chronic lung disease)
Exertional dyspnoea + Syncope
Cyanosis
Hypoxia

Question 12

if diabetic what drug

Answer 12

ACEi first line

Question 13

A 65-year-old man with heart failure presents to his GP with some questions about some of his medications. He would like to know which of his drugs will help him to live longer and not just improve his symptoms.

What is the most appropriate response?

Answer 13

ACEi BB and spirono