Heart Failure

Question 1

What is Heart Failure?

Answer 1

Failure of the heart to function as a pump

Low cardiac output = fluid retention, increasing preload and stress on heart

Question 2

Heart failure causes

Answer 2

IHD, cardiomyopathy, HT, valve disease, congenital heart disease, cor pulmonale, arrhythmias, infections

Question 3

HF symptoms and signs

Answer 3

Exertional dysponea (orthop, PND), tiredness, pink frothy sputum, cardiomegaly, V hypertrophy, heart sounds S3, S4, crackles, pleural effusion, RH: raised JVP, ankle oedema, ascites, hepatomegaly

Question 4

What will CXR show?

Answer 4

ABCDE
A - Alveolar bat wings
B - Kerly B lines
C - Cardiomegaly
D - Dilation of prominent upper lobe vessels 
E - Pleural Effusion

Question 5

What will ECG show?

Answer 5

Ischaemia, HT, arrhythmia

Question 6

HF investigations

Answer 6

CXR, ECG, Echo, catheterisation

Question 7

What will echo show?

Answer 7

Structural function

Question 8

What will catheterisation show?

Answer 8

If IHD (for diagnosis)
Eligibility for revascularisation

Question 9

Immediate treatment of HF

Answer 9

Site up
Oxygen (100% if no pre-existing lung disease)
Furosemide 40-80mg IV slowly
Morphine e.g. diamorphine 2.5-5mg IV slowly

Question 10

Chronic treatment of HF

Answer 10

1. Lifestyle
2. Diuretics to treat fluid overload
3. ACEI/ARBs + B-blocker (start low, go slow)
4. Spirinolactone, digoxin, other vasodilators in later stages
5. Invasive therapy: revasc(CABG), CRT, ICDs§

Question 11

LHF

Answer 11

Pulmonary oedema, pink frothy sputum, dyspnoea, PND, fine end creps, pleural effusion, S3

Question 12

RHF

Answer 12

Peripheral oedema (sacrum, ankles), elevated JVP, hepatomegaly, ascites