Heart Failure

Question 1

An elevated JVP is more suggestive of…?

Answer 1

Right sided heart failure

Question 2

Pulmonary hypertension can lead to…?

Answer 2

Right sided heart failure

Question 3

Stages of Management of Left Ventricular Failure

Answer 3

1 - Sit parient upright
2 - Administer 100% O2 through a trauma mask
3 - Establish venous access
(If patient needs opiates, administer IV diamorphine and IV metaclopramide)
4 - Administer IV frusemide 80-100mg
5 - Insert urinary catheter
(Patient with systolic BP >110, with pulmonary oedema and no history of mitral/aortic stenosis, administer IV nitrates)
6 - Continuous positive airway pressure

Question 4

What is Congestive Cardiac Failure?

Answer 4

A syndrome

Collection of pathologies which result in low cardiac output and fluid retention

Question 5

Common causes of left sided heart failure?

Answer 5

Ischaemic heart disease
Previous MI
Cardiomyopathy
Valvular disease

Question 6

Common causes of right sided heart failure?

Answer 6

Secondary to left heart failure
Cor pulmonale
Congenital heart disease

Question 7

Symptoms of left heart failure?

Answer 7

Dyspnoea on exertion/rest
Orthopnoea (fluid falls to lungs soon lying down)
PND
Pulmonary oedema (sudden dyspnoea, pink frothy sputum)

Question 8

Signs of left heart failure?

Answer 8

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

Question 9

Signs of left heart failure on CXR?

Answer 9

Cardiomegaly
Bats wing shadows (esp. lower zones)
Interstitial fluid

Question 10

Symptoms of right heart failure?

Answer 10

Peripheral oedema

Question 11

Signs of right heart failure?

Answer 11

Ankle/sacral oedema
Elevated JVP
Hepatomegaly
Ascites

Question 12

Signs of right heart failure on CXR?

Answer 12

Normal

Question 13

Treatment of CCF due to previous MI or Cardiomyopathies?

Answer 13

Standard Medical Therapy 
Diuretics 
ACE Inhibitors 
Beta Blockers (caution) 
Spironolactone in severe cases 

Digoxin 
Other vasodilators (nitrates, hydralazine) 

Implantable Cardiac Defibrillators
Cardiac Resynchronisation Therapy
Transplantation

Question 14

Treatment of CCF due to Cor Pulmonale?

Answer 14

Diuretics and oxygen only

Question 15

Treatment of CCF due to valvular disease?

Answer 15

Ideally surgery

Question 16

Treatment of CCF due to fast AF?

Answer 16

Digoxin or DC shock

Question 17

Use of diuretics in CCF?

Answer 17

To excrete retained fluid
Thiazides for mild CCF only
Loops used more commonly

Question 18

Why are loop diuretics administered alongside ACE inhibitors?

Answer 18

Loop diuretics cause loss of K

ACE inhibitors help retain and normalise K levels

Question 19

Use of beta blockers in CCF?

Answer 19

Can worsen CCF in short term, but beneficial in long term

Start low, go slow

Question 20

Initial risks of beta blockers in CCF?

Answer 20

Hypotension

Worsening dyspnoea

Question 21

Why might ivabradine be used in CCF?

Answer 21

Fast heart rate despite use of beta blockers

Only works when heart is in sinus rhythm

Question 22

What is the purpose of an ICD?

Answer 22

Detect arrhythmias and deliver a shock to the heart

Question 23

What is the purpose of CRT and when might it be used?

Answer 23

Only used for prolonged QRS due to unsynchronised contracting of the right and left sides of the heart
Biventricular pacing - forces right and left to contract together

Question 24

Acute LVF Therapy?

Answer 24

Sit up = Fluid does away from the lungs 
Oxygen therapy 
IV furosemide = Combat fluid retention and causes vasodilatation 
IV diamorphine (not in COPD)

Question 25

What are the features of heart failure due to diastolic dysfunction?

Answer 25

LV hypertrophy
Lack of cardiomegaly r LV dilation
S4 heart sounds

Question 26

Impaired left ventricular relaxation, increased end diastolic pressure and normal end-systolic volume are a result of which dysfunction?

Answer 26

Diastolic

Question 27

Why might diastolic dysfunction occur?

Answer 27

LV hypertrophy
LV stiffness
Impaired LV relaxation