Heart Failure

Question 1

Chronic heart failure

Answer 1

clinical features of impaired heart function

Question 2

Impaired left ventricular function
what experiences an increase volume and pressure of blood?

Answer 2

left atrium, pulmonary veins and lungs

Question 3

What does a preserved ejection fraction mean?

Answer 3

> 50%
diastolic dysfunction where there is an issue with left ventricle filling during diastole

Question 4

causes of HF?

Answer 4

valvular heart disease (aortic stenosis)
HTN
arrhythmias - afib
cardiomyopathy

Question 5

symptoms of chronic heart failure are?

Answer 5

Breathlessness
cough
Orthopnoea
Paroxysmal Nocturnal Dyspnoea
peripheral oedema
Fatigue

Question 6

PND mechanism?

Answer 6

fluid settles across large SA of lungs = breathless

fluid sinks to bases

Secondly during sleep the respiratory centre becomes less responsive

s= congestion and hypoxia

less adrenalin = myocardium is more relaxed = reduced CO

Question 7

assessment for HF

Answer 7

NT-proBNP blood test
ECG
Echocardiogram

Question 8

NYHA

Answer 8

Class I: no limitation
Class II: Comfortable at rest
Class III: symptomatic with any activity
Class IV symptomatic at rest

Question 9

NT-proBNP

Answer 9

400-2000 echo within 6 weeks
>2000 ng/litre within 2 weeks

Question 10

investigations ?

Answer 10

NT-proBNP blood test
ECG
Echo

Question 11

when are aldosterone antagonists used?

Answer 11

reduced ejection fraction and symptoms are not controlled with ACEi and beta blocker

Question 12

CO?

Answer 12

volume of blood ejected by heart per minute

Question 13

stroke volume

Answer 13

volume of blood ejected during each beat

Question 14

CO

Answer 14

SV x HR

Question 15

pulmonary oedema.

Answer 15

lung tissue and alveoli are filled with interstitial fluid

Question 16

Acute LVF

Answer 16

SOB acutely
type 1 respiratory failure low 02 without an increased CO2

cough with frothy white / pink sputum

Question 17

Signs on examination

Answer 17

Raised respiratory rate

Reduced oxygen saturations

Tachycardia (fast heart rate)

3rd heart sound

Bilateral basal crackles (sounding “wet”) on auscultation of the lungs

Hypotension in severe cases cardiogenic shock

Question 18

mx of acute LVF?

Answer 18

A-E approach
ECG
bloods > anaemia, infection markers, renal screen, BNP consider troponin

ABg
chest XRay
echo

Question 19

what is b type natriuretic peptide?

Answer 19

hormone released from the ventricles when the cardiac muscle is stretched beyond the normal range