Heart Failure

Question 1

Define heart failure

Answer 1

A state in which the heart fails to maintain an adequate circulation for the needs of the body despite an adequate filling pressure.

Question 2

Causes of heart failure?

Answer 2

Ischaemic heart disease
Hypertension
Congenital heart diseases
Restrictive cardiac myopathy
Hypertrophic cardiac myopathy
Arrhythmias
Pericardial disease

Question 3

What is Class I heart disease?

Answer 3

No symptomatic limitation of physical activity

Question 4

What is seen in class II heart disease?

Answer 4

Slight limitation of physical activity
Ordinary physical activity results in symptoms
No symptoms at rest

Question 5

What is seen in class III heart disease?

Answer 5

Marked limitation of physical activity - leads to symtoms

No symptoms at rest

Question 6

What is seen in class IV heart disease?

Answer 6

Inability to carry out physical activity without symptoms

May have symptoms at rest

Question 7

Cardiac output of the heart normally?

Answer 7

5L/minute

Question 8

Stroke volume of the heart?

Answer 8

75ml/beat

Question 9

What are the factors that affect cardiac output?

Answer 9

Heart rate
Myocardial contractility
Venous capacity (LV preload)
Aortic and peripheral impedance (afterload)

Question 10

Signs and symptoms of left sided heart failure?

Answer 10

Fatigue
Shortness of breath upon exertion or when lying flat
Tachycardia
Cardiomegaly
S3 or S4 heart sounds
Functional murmur of mitral regurgitation
Basal pulmonary crackles
Pulmonary oedema

Question 11

What is congestive heart failure?

Answer 11

When both sides are affected

Question 12

Causes of right sided heart failure?

Answer 12

Secondary to left heart failure
Chronic lung disease
Pulmonary embolism
Pulmonary hypertension
Pulmonary/tricuspid valvular disease
Left -> right shunts (ASD/VSD)
Isolated right ventricular cardiomyopathy

Question 13

What is cardiomegaly?

Answer 13

Displaced apex beat

Question 14

Signs/symptoms of right sided heart failure?

Answer 14

Peripheral oedema
Fatigue
Dyspnoea
Anorexia
Nausea
Raised JVP
Tender, smooth hepatic enlargement
Dependent pitting oedema
Pleural effusion

Question 15

How is angiotensin II produced?

Answer 15

Drop in blood pressure causes release of renin in kidneys
Angiotensin -> Angiotensin I
Angiotensin I -> Angiotensin II (ACE)

Question 16

What does angiotensin II do?

Answer 16

Powerful vasoconstrictor

Promotes release of aldosterone from the kidneys

Question 17

What does aldosterone do?

Answer 17

Causes salt and water retention in the kidneys, increasing blood volume

Question 18

Which receptor causes vasoconstriction of blood vessels?

Answer 18

alpha-1

Question 19

Which receptor increases chronotropy and inotropy?

Answer 19

beta-1

Question 20

Which drugs are used in the treatment of heart failure?

Answer 20

ACE-inhibitors
Diuretics
Beta-blockers

Question 21

How do ACE-inhibitors work?

Answer 21

Prevent conversion of angiotensin I to II
Indirect vasodilatory effect and diuretic effect
Reduces workload of the heart

Question 22

What do beta blockers do in the treatment of heart failure?

Answer 22

Block beta-1 receptors on the myocardium
Lowers chronotropy and inotropy
Reduces workload of the heart

Question 23

Aims of pharmacological therapy in heart failure?

Answer 23

Symptomatic improvements
Delay progression of heart failure
Reduce mortality

Question 24

What do calcium channel blockers do in the treatment of heart failure?

Answer 24

Reduce contractility of the myocardium

Question 25

What do organic nitrates do?

Answer 25

Veno/vasodilator to reduce blood pressure

Question 26

What do cardiac glycosides do?

Answer 26

Increase cardiac output and contractility of the heart by inhibiting the Na-K pump
This raises intracellular Na, inhibiting the NCX, so intracellular calcium increases
Increase in contractility