Heart Failure

Question 1

Main causes of left heart failure

Answer 1

IHD
Cardiomyopathy
Valvular disease

Question 2

Main causes of right heart failure

Answer 2

2ndry to left heart failure
Cor pulmonale
Congenital heart disease

Question 3

LVF signs

Answer 3

Tachycardia
Fine crepitations
Pleural effusion
S3
(Gallop rhythm = S3 + tachycardia)

Question 4

Bats wing shadows (esp lower zones)

Answer 4

LVF

Question 5

CXR signs of LVF?

Answer 5

Cardiomegaly
Bats wings shadows (esp lower zones)
Interstitial fluid

Question 6

Right heart failure signs?

Answer 6

Oedema (ankle/sacral)
JVP elevated
Hepatomegaly
Ascites

-CXR normal

Question 7

Treatment for Cor Pulmonale / CCF

Answer 7

Diuretics and digoxin only

Question 8

Treatment for CCF caused by vavlular disease?

Answer 8

Surgery ideally

Question 9

Treatment for heart failure caused by AF?

Answer 9

Digoxin or DC shock

Question 10

Standard treatment for CCF?

Answer 10

Diuretics to excrete retained fluid
Angiotensin converting enzyme inhibitors
Beta Blockers (caution required)
Spironolactone (severe cases only)

Digoxin (used as an add on if already on beta blockers and ACEi)
Other vasodilators (nitrates, hydralazine)

Implantable cardiac defibrillators
Cardiac resynchronisation therapy
Transplantation

Question 11

Therapy for acute LVF

Answer 11

1) Sit up
2) Oxygen
3) IV frusemide
4) IV diamorphine (not in COPD)

Question 12

Blood tests

Answer 12

FBC
Liver biochem
Urea and electrolytes
Cardiac enzymes in acute heart failure (will be raised, released in response to stretch)

Question 13

CXR

Answer 13

Cardiomegaly
Bats wings
Effusion
Kerley B lines
Pulmonary oedema

(normal in right heart failure)

Question 14

ECG

Answer 14

Look for ischaemia, hypertension or arrhythmia

Question 15

Beta blockers in heart failure, what should you watch out for?

Answer 15

Caution in obstructive airway disease, bradyarrhythmias

Avoid in acute heart failure until cardiovascularly stable

Question 16

When should you be careful with digoxin?

Answer 16

Caution in renal impairment, conduction disease and if on amiodarone

Question 17

Drugs which improve survival rate?

Answer 17

ACEi
Beta-blockers
Spironolactone
Eplerenone
Hydralazine in combination with nitrates

Question 18

What does GTN do?

Answer 18

Reduces pulmonary congestion
Low dose venodilation
High dose arterial vasodilation

Question 19

What does morphine do?

Answer 19

Relieves dysponea
Venous and arterial dilatation
Heart rate reduction

Question 20

What does dobutamine do?

Answer 20

Increases HR, CO, diuresis, vasodilation