Heart failure

Question 1

Definition of heart failure?

Answer 1

CO is inadequate for the body’s requirements despite adequate filling pressures.

Question 2

Right ventricular failure causes

Answer 2

• LVF
• Cor pulmonale
• Tricuspid and pulmonary valve disease

Question 3

Right ventricular failure symptoms

Answer 3

Anorexia and nausea

Question 4

Right ventricular failure signs

Answer 4

• ↑JVP + jugular venous distension
• Tender smooth hepatomegaly (may be pulsatile)
• Pitting oedema
• Ascites

Question 5

Left ventricular failure causes

Answer 5

1st: IHD
2nd: idiopathic dilated cardiomyopathy
3rd: Systemic HTN
4th: Mitral and aortic valve disease

Question 6

Left ventricular failure Symptoms

Answer 6

• Fatigue
• Exertional dyspnoea
• Orthopnoea + PND
• Nocturnal cough (± pink, frothy sputum)
• Wt. loss and muscle wasting

Question 7

Left ventricular failure signs

Answer 7

• Cold peripheries ± cyanosis
• Often in AF
• Cardiomegaly ̄c displaced apex
• S3 + tachycardia = gallop rhythm
• Wheeze (cardiac asthma)
• Bibasal creps

Question 8

Diagnosis of heart failure?

Answer 8

Framingham Criteria

- 2 major criteria or 1 major + 2 minor

Question 9

MajorFramingham criteria

Answer 9

• PND
• +ve abdominojugular reflux
• S3
• Basal creps
• Cardiomegaly
• Acute pulmonary oedema
• ↑ CVP (>16cmH2O)
• Wt. loss >4.5kg in 5d secondary to Rx

Question 10

Minor Framingham criteria

Answer 10

• Bilat ankle oedema
• SOB
• ↑HR >120
• Nocturnal cough
• Hepatomegaly
• Pleural effusion
• 30% ↓ vital capacity

Question 11

New York Heart Association Classification of heart failure?

Answer 11

New York Heart Association Classification

1. No limitation of activity
2. Comfortable @ rest, dyspnoea on ordinary activity 3. Marked limitation of ordinary activity
3. Dyspnoea @ rest, all activity → discomfort

Question 12

Management of heart failure?

Answer 12

ACEi: ramipril
β-B: bisoprolol
Loop diuretic: furosemide
(+ spironolactone)