Heart Failure

Question 1

Prognosis of heart failure

Answer 1

20-50% die within 5 years of diagnosis

Poor!!

Question 2

Prevalence of heart failure

Answer 2

1-3% of population

10% amongst elderly

Question 3

Difference between systolic and diastolic failure

Answer 3

Systolic - inability for heart to contact normally - Ef 50%

Question 4

Causes of systolic and diastolic

Answer 4

Systolic - IHD, MI, cardiomyopathy

Diastolic - constrictive pericarditis, tamponade, restrictive cardiomyopathy, HTN

Question 5

Symptoms of LVF

Answer 5

Dyspnoea, orthopnoea, PND, poor exercise tolerance, fatigue, nocturnal cough (pink frothy) wheeze, cold peripheries, wl and muscle wasting

Question 6

Symptoms of RVF

Answer 6

Peripheral oedema, ascites, nausea, anorexia, facial enforcement, epistaxis, pulsation in face and neck

Question 7

Causes of RVF

Answer 7

LVF, pulmonary stenosis, lung disease

Question 8

Signs of acute heart failure

Answer 8

Pulmonary and or peripheral oedema with or without signs of peripheral hypo perfusion

Question 9

3 types of low-output heart failure

Answer 9

Pump failure (systolic or diastolic hf, drugs, deceased heart rate) 
Excessive preload (mitral regurge or fluid overload) 
Chronic excessive after load (aortic stenosis, HTN)

Question 10

What is high output heart failure?

Answer 10

Heart okay but requirement is increased too much

Eg. Anaemia, pregnancy, hyperthyroidism, Paget’s disease, AVM, beri beri

Question 11

Investigations in heart failure

Answer 11

ECG likely to be abnormal - showing cause of heart failure

BNP - if normal heart failure is unlikely

Echo

CXR

Question 12

CXR in left ventricular failure

Answer 12

ABCDE
Alveolar oedema (bats wings - hilar shadowing)
B - kerley b lines (interstitial oedema)
C - cardiomegaly
D - dilated prominent upper lobe vessels
E - pleural Effusion

Question 13

Conservative management of chronic heart failure

Answer 13

Stop smoking
Eat less salt
Optimise weight and nutrition

Treat cause or exacerbating factors

Question 14

Drugs to avoid in heart failure

Answer 14

NSAIDs (fluid retention)

Verapamil (-ive inotrope)

Question 15

Drug treatment of HF

Answer 15

Diuretics 
ace-I 
Beta-blocker 
Sprionolactone
Digoxin

Question 16

Diuretics in HF

Answer 16

Furosemide or bumetanide

Spironolactone - if K+ low, arrhythmia predisposition, concurrent digoxin therapy

Question 17

When ace-I in heart failure

Answer 17

LV systolic dysfunction

Question 18

BNP for diagnosing heart failure

Answer 18

> 100ng/L

Can be used to rule out if

Question 19

What is heart failure?

Answer 19

Deceased cardiac output so it’s insufficient to meant body’s requirements