Heart Failure

Question 1

What is Congestive cardiac failure?

Answer 1

Inability of the heart to pump adequate blood to the body circulation.
mostly due to LOW CO.

Question 2

What are the types of heart failure?

Answer 2

• R sided
• L sided
• Mixed
• Acute LVF
• Chronic LVF

Question 3

What are the causes of heart failure?

Answer 3

1. L
   - IHD, MI
   - Cardiomyopathy
   - Valvular disease
2. R
   - 2ndary to LHF
   - Cor pulmonale
   - Congenital heart disease

Question 4

Symptoms of Left heart failure?

Answer 4

• Dyspnoea (exertion/rest)
• Orthopnoea (SOB lying flat)
• Paroxysmal nocturnal dyspnoea (SOB at night)
• Pulmonary oedema (sudden dyspnoea, pink frothy sputum)

Question 5

Signs of Left hf?

Answer 5

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

CXR:

• Cardiomegaly
• Bats wings shadows lower zone
• interstitial fluid

Question 6

Symptoms and signs of R heart failure?

Answer 6

Symptoms:
- Systemic oedema

Signs:

• Ankle/sacral oedema
• Raised JVP (>4cm above sternal angle)
• Ascites (fluid filling in peritoneal cavity= swollen abdomen)

Question 7

What is the specific treatment for CCF, if its due to:

a) Cor pulmonale
b) Valvular disease
c) Fast AF

Answer 7

a) RX diuretics + Oxygen
b) surgical intervention
c) Digoxin, DC shock

Question 8

What is the standard treatment for CCF?

Answer 8

• Diuretics: excrete water
• ACEI’s
• B Blockers (caution)
• Spironolactone (severe cases)

Vasodilators:

• Digoxin
• GTN
• Hydralazine

Defibrilator

Question 9

What is the effect of diuretics on K+? Example?

Answer 9

Loop diuretics used more.
Eg- Furosemide
Thiazides used for mild CCF.

Coincidental drugs- ACEI, Spironolactone, retain K+

Question 10

What is the mechanism of ACEI? Example? Side effects?

Answer 10

ACEI- Inhibits ACE which converts Angiotensin I to II.
Egs- Lisinopril, Enalapril, Captopril

Side effects:

• Cough (use ARB instead)
• Angioneurotic oedema
• 1st dose Hypotension
• Renal impairment

Question 11

Mechanism of ARB’s? Examples?

Answer 11

• Blocks Angiotensin II receptor.
  Mainly used in patients who experience cough with ACEI.
  Eg- Losartan, Valsartan

Question 12

Main use of B blockers? examples? Side effects?

Answer 12

Slows HR and force of contraction. Reduces workload on heart.

Initially may cause hypotension and more dyspnoea. Start and increase dose slowly.

Eg:

• B1 selective: Bisoprolol
• non selective- Carvedilol

Question 13

What does Spirnolactone do? Side effects?

Answer 13

Blocks Aldsoterone receptor (antagonist). Only used in severe CCF

Side effects

• Hyperkalaemia
• Renal dysfunction

Question 14

Effect of Ivabradine on HR?

Answer 14

Slows HR. only use if B blocker cannot sufficiently reduce HR

Question 15

When is Digoxin used? Side effects?

Answer 15

Used to treat AF
Effect- Slows down fast AF.

Side effects- Bradycardia, Heart block, nausea, vomiting.
Ventricular arrhythmias.