Heart Failure

Question 1

Which drugs improve mortality for patients with heart failure?

Answer 1

Ace I
Spironolactone
Beta blockers
Hydralazine with nitrites

Question 2

Management of heart failure

Answer 2

First line : ACE and BB
Second: aldosterone antagonist, ARB2 or hyralazine with a nitrate (NOT ACE and ARB together)
Third: pacemaker, digoxin or ivabradine

Diuretics for fluid overload

Question 3

Causes of right heart failure?

And signs/ symptoms?

Answer 3

LVF
Cor pulmonale
Tricuspid and pulmonary valve disease

S/s - anorexia, nausea, ⬆️jvp, hepatomegaly, pitting oedema, ascites

Question 4

Causes of Left heart failure?

And s/s

Answer 4

1) IHD, 2) idiopathic dilated cardiomyopathy
3) systemic HTN, 4) mitral and aortic disease 5) cardiomyopathy

S/s
Fatigue, dyspnoe (exertional), Orthopoea, nocturnal cough and pink frothy sputum, cold peripheries, AF common, cardiomegaly, s3 + gallop rhythm, wheeze, basal creps

Question 5

Causes of raised BNP?

Answer 5

LVH
Ischemia
Tachycardia
RV overload
Hypoximia 
Sepsis
Diabetes

Question 6

Causes of decrease BNP levels?

Answer 6

Obesity
Diuretics
Ace i
B blockers
ABRs
Aldosterone antagonists

Question 7

Diagnosis of Congestive cardiac failure: Framingham criteria

Answer 7

2 major or 1 major and 2 minor

Major:
PND, neck vein distension, crepitations, s3 gallop, cardiomegaly, acute pulm oedema, hepatojugular reflux, raised CVP (⬆️16), wt loss >4.5kg in 5 days 2’ to treatment

Minor:
Bilateral ankle oedema, SOBOE, HR ⬆️120, nocturnal cough, hepatmegly, pleural effusion, 30% ⬇️ vital capacity

Question 8

What’s the New York classification of heart failure

Answer 8

1) no Sx, no limitation to ordinary activity
2) mild Sx, slight limitation of physical activity (comfortable at rest)
3) mod Sx, marked limitation of physical activity (comfortable at rest)
4) severe Sx, present at rest but increased discomfort with any physical activity.

Question 9

Acute heart failure management?

Answer 9

Oxygen
IV diuretics
Opiates
Vasodilator 
Inotropic agents
CPAP
Ultrafiltration
Mechinical circulatory assistance

Question 10

How is morphine helpful in acute heart failure?

Answer 10

Reduces dyspnoea and anxiety

Has vasodilator properties - decreases sympathetic drive

Question 11

Top 3 causes of heart failure

Answer 11

IHD
Cardiomyopathy
Hypertension

Question 12

What are the poor prognostic features in acute heart failure?

Answer 12

Pulmonary oedema

High pulmonary capillary wedge pressure
Hyponatermia
Low oxygen consumption