Heart failure

Question 1

What is heart failure?

Answer 1

impaired ability of the heart to function as a pump to support a physiological circulation

Question 2

What are the main causes of heart failure? (4)

Answer 2

Ischaemic heart disease
Dilated cardiomyopathy
Hypertension
Valvular heart disease

Question 3

What are the two main physiological responses to decreased cardiac output, and their main consequences?

Answer 3

Adrenergic activation- positively inotropic and chronotropic, vasoconstriction
Renin-angiotensin activation causing salt and water retention, vasoconstriction

Question 4

What overall consequence do the physiological responses to decreased cardiac output have in heart failure?

Answer 4

Increase the cardiac preload and afterload, thus exacerbating the heart failure

Question 5

What is left ventricular systolic dysfunction defined as?

Answer 5

Left ventricular ejection fraction <40% on echocardiography

Question 6

What is high-output failure?

Answer 6

Cardiac output is normal, or increased in the face of increased need

Question 7

Causes of high-output failure? (4)

Answer 7

Anaemia
Pregnancy
Hyperthyroidism
Paget’s disease of bone

Question 8

Symptoms of heart failure (6)

Answer 8

SOB and fatigue
Dependent oedema
Ascites
Orthopnoea
Paroxysmal nocturnal dyspnoea
Nocturnal cough + pink frothy sputum`

Question 9

Signs of heart failure (7)

Answer 9

ill and exhausted-looking
peripheral oedema
bilateral basal crackles
tachycardia at rest
raised JVP
tender hepatomegaly
gallop rhythm due to presence of S3

Question 10

Function of ECG in cardiac failure?

Answer 10

Identification of precipitants e.g. ischaemia, arrythmia, hypertension (heart strain patterns)

Question 11

Chest X-ray signs in heart failure?

Answer 11

Cardiomegaly
Pleural effusions
Fluid in the fissures
Pulmonary oedema
Prominent upper lobe veins (upper lobe diversion)

Question 12

First-line management for heart failure?

Answer 12

ACE inhibitor + beta blocker

Question 13

Second-line management for heart failure?

Answer 13

Add on one of the following:

aldosterone antagonist (spironolactone)
ARB (if not already on ace inhibitor)
hydralazine + nitrate

Question 14

3rd line options for heart failure? (3)

Answer 14

Digoxin
Cardiac resynchronization
Ivabradine

Question 15

Treatment for fluid overload in heart failure?

Answer 15

Furosemide

Question 16

Management of severe dypsneoa in acute pulmonary oedema?

Answer 16

IV furosemide- if failed, consider CPAP

Question 17

NYHA classification of heart failure?

Answer 17

Class I- no symptoms
Class II- comfortable at rest; ordinary activity results in fatigue, palpitations or dypsnoea
Class III- comfortable at rest, less than ordinary activity results in symptoms
Class IV- symptoms present at rest

Question 18

Diagnosis of heart failure if:

a) patient has had previous MI
b) no previous MI

Answer 18

a) echo

b) measure BNP; if raised/high arrange echo

Question 19

What is BNP?

Answer 19

Hormone produced by left ventricular myocardium in response to strain