Heart Failure

Question 1

typical symptoms of HF

Answer 1

breathlessness
fluid retention
fatigue (decreased exercise tolerance or increased recovery time after exercise)
lightheadedness or history of syncope.

Question 2

risk factors of heart failure

Answer 2

AF, MI, hypertension
drugs including alcohol
family history of heart failure or sudden cardiac death under the age of 40

Question 3

what to examine for in HF?

Answer 3

tachycardia and pulse rhythm
laterally displaced apex beat, heart murmurs, 3rd/4th heart sounds.
hypertension
raised jugular venous pressure
obesity

Question 4

when to offer loop dieuretic?

Answer 4

if symptoms are sufficiently sever

Question 5

dosage of loop dieuretic

Answer 5

furosemide 20-40mg daily
bumetanide 05-10mg daily
toresamide 5-10mg daily

Question 6

management of confirmed HF with reduced ejection fraction

Answer 6

offer diuretic if symptoms of fluid overload.
offering ACE + BB to all patients
offer MRA in addition to ACE + BB does not help with symptoms
seeking specialist help if patient still has symptoms

Question 7

management of HF with mildly reduced ejection fraction

Answer 7

offering diuretics if symptoms of fluid overload.
consider offering ACEI, BB MRA.

Question 8

management of HF with preserved ejection fraction

Answer 8

low to medium dose of diuretic if necessary and arrange specialist referral if there is no response to treatment.

Question 9

management in all people with confirmed heart failure

Answer 9

anti-platelet drugs and statins should be considered.
screening for depression/anxiety
nutritional status should be observed
self care advice should be given
appropriate vaccines should be given

Question 10

diagnosis of heart failure

Answer 10

detailed history and examination
nt pro bnp level
12 lead ECG

can consider other tests to rule out any other conditions:
chest x ray
blood tests such as, urea and electrolytes, liver function test, thyroid tests, full blood count.
urine dipstick to test for protein and blood
lung function tests (peak flow/spirometry)

assess and manage for any underlying disease - People with heart failure due to valve disease should be referred for specialist assessment and given advice regarding follow up

loop dieuretics may be prescribed to relieve symptoms.

Question 11

if serum Natriuretic peptide levels are high what can be done?

Answer 11

referral for specialist assessment and transthoracic echo cardiograph within 2 weeks.

Question 12

NT pro bnp levels above 2000 ng/l (236pmol/l)

Answer 12

should be referred urgently for specialist treatment and transthoracic echo cardiograph within 2 weeks.

Question 13

NT pro bnp levels 400-2000ng/l (47-236 pmol/l)

Answer 13

should be referred urgently for specialist treatment and transthoracic echo cardiograph within 6 weeks

Question 14

management of confirmed HF with reduced ejection fraction

Answer 14

offer dieuretic if symptoms of fluid overload
offering ace and BB to all people
offering MRA in addition to ace and bb if patient remains with symptoms
seeking specialist help if patient still has symptoms

Question 15

management of confirmed HF with mildly reduced ejection fraction

Answer 15

offering dieuretics is symptoms of fluid overload
consider offering ACEI, BB and MRA

Question 16

management of confirmed HF with preserved ejection fraction

Answer 16

low to medium dose dieuretic if necessary and arranging specialist referral if there is no response to treatment.

Question 17

management in all people with confirmed HF

Answer 17

anti-platelet drugs and statins should be considered
screening for depression and anxiety
nutritional status should be assessed
self care advice should be given
appropriate vaccines should be given

Question 18

what is heart failure?

Answer 18

complex clinical syndrome that results from hearts inability to provide sufficient cardiac output and blood flow to meet metabolic requirements/ accomodate systemic venous return.