Heart failure

Question 1

What is heart failure?

Answer 1

A syndrome as lots of different heart conditions can cause a reduction in heart function and cause heart failure

Question 2

What are the different types of heart failure?

Answer 2

LHF
RHF
Mixed
Acute or chronic

Question 3

Why does the body retain fluid in heart failure?

Answer 3

When CO is low, the kidneys are underperfused and so will retain water and salt to increase BP

Question 4

What are the commonest causes of LHF?

Answer 4

Ischaemic heart disease - previous MIs
Cardiomyopathy
Valvular disease

Question 5

Why does previous MIs cause heart failure?

Answer 5

When heart muscle dies, it will scar preventing the heart from pumping properly

Question 6

What conditions can cause RHF?

Answer 6

Secondary to left heart failure
Cor pulmonale
Congenital heart disease

Question 7

What is cor pulmonale?

Answer 7

A disease in which any severe lung disease can put a strain on the right side of the heart which will cause it to fail

Question 8

What are the symptom of LVF?

Answer 8

Dyspnoea on exertion or rest
Orthopnoea
PND
Pulmonary oedema (sudden dysnpoea, pink frothy sputum)

Question 9

What are the clinical signs of LVF?

Answer 9

Tachycardia
Fine crepitations
Pleural effusion (can be LVF or lung cancer)
S3 (lub de dub). The combination of S3 with tachycardia sounds like a horse galloping (Kentucky)

Question 10

What are the CXR signs of LVF?

Answer 10

Cardiomegaly
Bats wing shadows esp. in lower zones
Interstitial fluid

Question 11

What are symptoms of RVF?

Answer 11

Oedema

Question 12

What are the clinical signs of RVF?

Answer 12

Oedema (ankle, sacral)
Elevated JVP
Hepatomegaly
Ascites

Question 13

What are the CXR findings of RVF?

Answer 13

Normal

Question 14

What is the treatment of cor pulmonale?

Answer 14

Diuretics and oxygen

Question 15

What is the treatment of valvular disease?

Answer 15

Drugs won’t work as the problem isn’t with the contractility of the heart but the valves so surgery is needed

Question 16

What is the treatment of fast AF?

Answer 16

Digoxin, beta blockers or DC shock

Question 17

How can fast AF cause CCF?

Answer 17

The ventricles beat too quickly due to fibrillating atria and so empty before it fills. Therefore a drug is needed to block the conduction between the atria and ventricles to allow the ventricles to fill properly

Question 18

What is the standard medical treatment for CCF?

Answer 18

Diuretics to excrete retained fluid 
ACECI 
Beta blockers 
Sprinolactone (severe cases) 
Digoxin 
Other vasodilators (nitrates, hydralazine) 
Implanted cardiac defibrillators 
Cardiac resynchronisation therapy 
Transplantation

Question 19

What diuretics are used in the treatment of CCF?

Answer 19

Thiazide for mild CCF

Loop diuretics common - furosemide but this can cause hypokalaemia so monitor potassium levels

Question 20

What are side effects of ACEI?

Answer 20

Angioneurotic oedema
First dose hypotension esp. if serum Na is low
Renal impairment (UE must be monitored after ACEI begun)
If cough, use ARBs instead (losartan)

Question 21

What are side effects of beta blockers?

Answer 21

Hypotension

Worsening dyspnoea

Question 22

What are side effects of spironolactone?

Answer 22

Hyperkalaemia
Renal dysfunction
Gynaecomastia