Heart Failure

Question 1

What are the aetiologies?

Answer 1

Ischaemic heart Disease
Cardiomyopathy
Hypertension

Question 2

What is the pathophysiology?

Answer 2

Problems with 
Venous return
Outflow resistance
Contractility of myocardium
Salt and water retention

Question 3

What are the symptoms?

Answer 3

Dyspnoea
Fatigue
Oedema
Reduced exercise capacity

Question 4

What are the signs?

Answer 4

Oedema
Tachycardia
Raised JVP
Chest crepitations
S3 heart sound
Cardiomyopathy
Abnormal apex beat

Question 5

What are the investigations?

Answer 5

BLOODS - FBC, LFTs, Us+Es, Cardiac enzymes, BNP
CHEST X-RAY - Cardiomegaly, Pulmonary congestion, Fluid in fissures
ELECTROCARDIOGRAM - Ischaemia, Hypertension, Arrhythmias
ECHOCARDIOGRAM - Systolic and diastolic function, Chamber dimensions, Valvular heart disease
CORONARY ANGIOGRAPHY - essential if chest pain
CARDIAC MR - Infarction, Inflammation and fibrosis

Question 6

What are needed for the diagnosis of heart failure?

Answer 6

Symptoms and signs on heart failure on rest or exercise
Objective evidence of cardiac dysfunction such as an echo
And a response to therapy in doubtful cases

Question 7

What are the treatments?

Answer 7

DIURETICS - promote renal excretion of salt and water, given in patients with fluid overload
ACEI - symptomatic and prognostic improvement
BETA BLOCKERS - potentially hazardous, precipitate severe deterioration, not for use in acute presentation

Question 8

What are the ADRs of diuretics?

Answer 8

Hypotension, hpokalaemia

Question 9

What are the ADRs of ACEIs?

Answer 9

First dose hypertension and cough

Question 10

What are the drug-drug interactions of ACEIs?

Answer 10

NSAIDs, Potassium supplements and potassium sparing diuretics