Heart Failure

Question 1

What is heart failure?

Answer 1

The heart is unable to pump blood efficiently around the body to meet the news of the body. This is a chronic condition.
Can be left sided, right sided or congestive (both sides)

Question 2

What are some causes of heart failure?

Answer 2

Ischaemic Heart Disease 
Hypertension
Dilated Cardiomyopathy - infection, alcohol, pregnancy
Valvular heart disease
Amyloidosis 
Arrhythmias

Question 3

What are the signs of left sided heart failure?

Answer 3

Crackles at lung bases - pulmonary oedema
Peripheral Cyanosis
Displaced apex beat - due to hypertrophy
Tachypnoea

Question 4

What are some signs of right sided heart failure?

Answer 4

Peripheral Oedema
Ascites
Liver Englargement - tender and smooth
Raised JVP
Sacral oedema - patients who are predominantly lying down
pleural effusion - stony dull on percussion

Question 5

What are some symptoms of left sided heart failure?

Answer 5

Fatigue
Shortness of breath
Breathlessness upon lying down - orthopnoea
A sudden night time attack of breathlessness - paroxymal nocturnal dyspnoea

Question 6

What are some symptoms of right sided heart failure?

Answer 6

Tiredness
Nocturia
Shortness of breath
Anorexia

Question 7

How does cor pulmonale occur?

Answer 7

Respiratory conditions cause pulmonary hypertension
The higher pressure within the pulmonary vessels causes an increase in pressure in the right ventricle which leads to right ventricular hypertrophy. Leads to the right ventricle becoming less efficient unable to pump as much blood.

Question 8

What are the risk factors for heart failure?

Answer 8

Previous MI 
AF
Valvular disease 
arrhythmias 
high BP
coronary heart disease

Question 9

Which system is commonly activated in Heart Failure?

Answer 9

RAAS
due to reduced renal blood flow
decreased NaCl concentration at the macula densa causes sympathetic stimulation of the JGA –> Renin
Causes elevated angiontensin 2

Question 10

What are some of the functions of Angiotensin 2?

Answer 10

Vasoconstriction
Promotes Left Ventricular hypertrophy and myocyte dysfunction
Promotes aldosterone release
Promotes sodium/water retention

Question 11

What are some causes of right sided heart failure?

Answer 11

Chronic Lung disease 
PE/pulmonary hypertension 
Pulmonary/tricuspid valvular disease 
Left to right shunts (ASD/VSD) 
Most frequent: secondary to left sided heart failure

Question 12

How is heart failure treated?

Answer 12

ACE inhibitors e.g. lisinopril, ramipril
Angiotensin receptor blockers e.g. losartan
Loop diuretics e.g. furosemide
beta blockers - take care and titrate up
Cardiac glycosides e.g. digoxin

Question 13

How does digoxin work?

Answer 13

Inhibits Na+/K+/ATPase on the myocardium this causes the reversal of the NCX causing an increase in intracellular calcium.
This causes increased contractility

Question 14

What are the physiological effects of Beta Blockers?

Answer 14

Reduce HR
Reduce BP
therefore reduce myocardial oxygen demand
inhibit renin release

Question 15

What is the mechanism of action of ACE inhibitors?

Answer 15

Blocks angiotensin converting enzyme which converts angiotensin 1 to ang 2.
This causes vasodilation and reduction in peripheral resistance and reduced sodium retention,
Reduces the breakdown of Bradykinin - vasodilator

Question 16

What are some side effects of ACE inhibitors?

Answer 16

Dry cough
Renal failure
Hyperkalaemia
Hypotension

Question 17

What is the mechanism of action of loop diuretics?

Answer 17

Inhibits the Na+/K+/ATPase symporter in the thick ascending loop of Henle.
Inhibits sodium, potassium and chloride re-absorption.

Question 18

What are some ADRs of loop diuretics?

Answer 18

Hypokalaemia 
Hyponatraemia 
dehydration 
postural hypotension 
Syncope

Question 19

What are some of the complications of Heart Failure?

Answer 19

Chronic Kidney Disease
Arrhythmias - ventricular and AF 
Cachexia 
Depression 
Sudden Cardiac Death