Heart Failure

Question 1

Acute heart failure can present in _ major forms

Answer 1

1) Acute pulmonary oedema
2) Predominant peripheral oedema with or without pulmonary oedema
3) Cardiogenic shock

Question 2

Acute Pulmonary Oedema:

Answer 2

Sudden development of interstitial oedema in the lungs with severe dyspnoea.
There may or may not be peripheral oedema.
It can occur suddently, or they may have some dyspnoea for days/weeks that suddenly worsens.

Question 3

Predominant peripheral oedema with or without pulmonary oedema:

Answer 3

Significant fluid loading, swollen legs, abdomen and scrotum.
Elevated jugular venous pressure and pleural effusions.

Question 4

Cardiogenic shock:

Answer 4

Heart can’t pump enough blood to meet the body’s needs.
Rare.
Commonest cause is STEMI.

Question 5

Symptoms of Left ventricular failure:

Answer 5

SOBOE
Pulomonary oedema
Bi-basal crepitations on auscultatoin

Question 6

Symptoms of Right ventricular failure:

Answer 6

Significant peripheral oedema
Ascites
Elevated JVP and pleural effusions
Clear auscultation

Question 7

Which is most common, left or right ventricular failure?

Answer 7

LEFT

Question 8

Describe pathophysiology of LVF:

Answer 8

Poor ventricular contraction occurs.
Blood therefore backs up into the lungs.
This increased pulmonary vein hydrostatic pressure
Causing fluid to enter the alveoli
= Pulmonary Oedema
This fluid in the alveoli reduces the gas exchange that occurs.

Question 9

Describe pathophysiology of RVF:

Answer 9

Primarily caused by LVF.
Can be caused in isolation due to lung diseases.
Failure of the right ventricle.
Reduced right ventricular stroke volume.
A) Blood accumulates in veins before the right atrium including the jugular vein = + JVP
B) An increase of venous hydrostatic pressure = flow of fluid from capillaries into the tissues = peripheral pitting oedema
C) Congests liver and spleen = URQ discomfort

Question 10

Triggers for acute heart failure:

Answer 10

MI
ACS
Tachyarrhythmia
Infection
+ BP
Non compliance with medication
Bradyarrhythmia
Toxins
Drugs
COPD exacerbation
PE

Question 11

Differential diagnoses:

Answer 11

COPD exacerbation
Sepsis
PE
Pneumonia

Question 12

Red flags for heart failure:

Answer 12

ORTHOPNOEA - breathlessness lying down. Have they slept in a chair overnight?
PAROXYSMAL NOCTURNAL DYSPNOEA - waking up SOB, relieved by sitting
NEW DYSPNOEA - with a hx of mI, HTN, angina
NEW PERIPHERAL OEDEMA
HAEMOPTYSIS