Heart Failure

Question 1

What is heart failure a general term for?

Answer 1

When the body’s cardiac output is inadequate for its needs

Question 2

What does acute heart failure present as?

Answer 2

Pulmonary oedema

Question 3

What does pulmonary oedema show on a CXR?

Answer 3

Prominent upper lobe vessels, cardiomegaly, alveolar ‘Bat’s wings’ appearance, Kerley B lines, pleural effusion

Question 4

What is heart failure due to?

Answer 4

Failure of any part of the heart

Question 5

What are two more specific causes of heart failure?

Answer 5

Cardiomyopathy (diseases of heart muscle) or pericardial diseases

Question 6

What can cause cardiomyopathy?

Answer 6

Metabolic, drugs, pregnancy

Question 7

What happens if the right side of the heart fails?

Answer 7

Back up of blood in the superior and inferior vena cava leading to congestion

Question 8

What happens if the left side of the heart fails?

Answer 8

Congestion in the lung fields (pulmonary oedema and impaired gas exchange) and decreased CO

Question 9

What can be some symptoms of heart failure?

Answer 9

SOB, reduced exercise tolerance, orthopnoea, PND, ankle swelling

Question 10

What is systolic heart failure?

Answer 10

Weakness or impairment of pump

Question 11

What is diastolic heart failure?

Answer 11

Heart is too stiff and doesn’t contract well- often caused by hypertension

Question 12

What is compensated heart failure?

Answer 12

Patients have heart failure but are generally well

Question 13

What is decompensated heart failure?

Answer 13

Stable patients become decompensated when they develop underlying conditions e.g. MI/arrhythmia, the disease progresses or there is a change in medication

Question 14

What are some differentials of heart failure?

Answer 14

Anything which causes shortness of breath i.e. pneumonia/pneumothorax

Question 15

How would you investigate for heart failure?

Answer 15

Full blood count, ABG, ECG, CXR, ECHO

Question 16

How can you classify heart failure?

Answer 16

NYHA classification from I-IV (no limitation, slight, marked, symptoms at rest)

Question 17

If the ECG is abnormal in heart failure, what will it show?

Answer 17

Bundle branch block- broad QRS waves, Q waves, poor R wave progression, sinus or not.

Question 18

What is the treatment for chronic heart failure?

Answer 18

• Treat the underlying cause
• Make patients feel better (give furosemide (diuretic) if pulmonary oedema)
• Make them live longer (ACE inhibitor, beta-blocker, ARB, devices e.g. ICD

Question 19

How should you prescribe ACE inhibitors?

Answer 19

Start at low dose and increase slowly

Question 20

When should beta-blockers be given in heart failure?

Answer 20

When the patient is stable

Question 21

What are initial risks of beta-blockers in heart failure?

Answer 21

Worsening dyspnoea, hypotension

Question 22

What type of drug is spironolactone and when is it used?

Answer 22

Aldosterone receptor antagonist used in moderate-severe heart failure

Question 23

What are side effects of spironolactone?

Answer 23

Hyperkalaemia, renal dysfunction, breast tenderness

Question 24

What does ivabradine do and when is it used in heart failure?

Answer 24

Slows the heart rate and is used when patients are on the maximum tolerated dose of beta blocker

Question 25

What are steps D and E in the acute treatment of heart failure?

Answer 25

Check blood glucose, oedema, patient comfort and dignity

Question 26

What is a common sign of pulmonary oedema?

Answer 26

Pink frothy sputum

Question 27

What medication do you give in acute heart failure before treating the underlying cause?

Answer 27

50mg IV furosemide and maybe repeat, opiates, nitrates, stop fluids