Heart Failure

Question 1

what is heart failure

Answer 1

(a.k.a congestive cardiac failure)

syndrome not one disease, due to low cardiac output in most cases

Question 2

what are the different types of heart failure

Answer 2

left, right and mixed

acute and chronic

Question 3

what causes the sign and symptoms of heart failure

Answer 3

fluid retention

Question 4

why does cardiac output cause fluid retention

Answer 4

when kidney is under perfused it retains salt and water

Question 5

what is left sided heart failure mainly due to

Answer 5

ischaemic heart disease, myocardial infarction, cardiomyopathy, valvular disease

Question 6

what is right sided heart failure mainly due to

Answer 6

secondary to left sided heart failure, cor pulmonale, congenital heart disease

Question 7

how does a myocardial infarction cause congestive cardiac failure

Answer 7

scar tissue replacing replacing healthy tissue doesn’t contract properly, reducing CO

Question 8

how does valvular disease cause congestive cardiac failure

Answer 8

valves not working properly, leaks so blood flows backwards/ forward reducing CO

Question 9

what is Cor pulmonale

Answer 9

when any lung disease puts a strain on the right side of the heart and it fails

Question 10

what are the symptoms of left ventricular failure

Answer 10

dyspnoea on exertion/rest,
orthopnoea,
paraoxysmal nocturnal dyspnoea,
pulmonary oedema (sudden dyspnoea and pink frothy sputum)

Question 11

describe orthopnoea in left ventricular failure

Answer 11

because of gravity, fluid in lungs shifts when lying down making shortness of breath worst

Question 12

describe paroxysmal nocturnal dyspnoea

Answer 12

patient wakes up breathless, rushes to window then feels better- can also be asthma in which breathlessness is worse at night

Question 13

what are the clinical signs of left ventricular failure

Answer 13

tachycardia, fine crepitations, pleural effusion, third heart sound (gallop rhythm = S3 + tachycardia)

Question 14

what can be seen on a CXR of someone with left ventricular failure

Answer 14

cardiomegaly, bats wing shadow esp. lower zones, interstitial fluid

Question 15

why is tachycardia associated with left ventricular failure

Answer 15

heart compensating for low CO

Question 16

what causes the crepitaitions in LVF

Answer 16

fluid accumulating in the lung bases

Question 17

what causes the pleural effusion in LVF

Answer 17

extra fluid in pleural cavity

Question 18

what causes the cardiomegaly

Answer 18

heart bigger to compensate for low CO

Question 19

what are the symptoms of right heart failure

Answer 19

oedema

Question 20

what are the clinical signs of right heart failure

Answer 20

oedema (ankle/sacral),
JVP elevated (>4cm above sternal angle),
hepatomegaly (abnormal enlargement of the liver),
ascites (fluid in the abdomen)

Question 21

what is seen in a CXR of someone with right side heart failure

Answer 21

normal

Question 22

in right side heart failure where does fluid collect

Answer 22

in VC, abdomen, ankles, stomach, neck, JVP

Question 23

how is heart failure caused by cor pulmonale treated

Answer 23

diuretics and oxygen only

Question 24

how is heart failure caused by valvular disease treated

Answer 24

surgery ideally

Question 25

how is heart failure caused by fast atrial fibrillation treated

Answer 25

digoxin or DC shock

Question 26

how does fast AF cause heart failure

Answer 26

ventricle beating too quickly doesn't have time to refill

Question 27

how is heart failure caused by fast AF treated

Answer 27

digoxin or DC shock (direct current- defibrillation)

Question 28

what causes of congestive cardiac failure are treates with the standard medical treatment of CCF

Answer 28

previous MIs and cardiomyopathies

Question 29

what is the standard medical treatment for CCF

Answer 29

diuretics to excrete retained fluid, angiotensin converting enzyme inhibitors, beta blockers, spironolactone (severe cases only) digoxin and other vasodilators (nitrates, hydralazine) implantable cardiac defibrillators, cardiac resynchronisation therapy, transplantation

Question 30

what does a diuretic do

Answer 30

causes an increase in urine

Question 31

what type of diuretics are used in CCF

Answer 31

loop diuretics and thiazide diuretics (for mild CCF only as less effective)

Question 32

give an example of a loop diuretic used in CCF

Answer 32

furosemide

Question 33

why are ace inhibitors and spironolactone benficial when using a diuretic to treat CCF

Answer 33

as diuretics can cause decrease in potassium in blood and these drugs can help retain and normalise K

Question 34

how do ACE inhibitors work

Answer 34

prevents angiotensin II being formed from angiotensin

Question 35

what do all ace inhibitors end in (give three examples)

Answer 35

pril: captopril, enalapril and lisinopril

Question 36

what are the side effects of ACE inhibitors

Answer 36

``` angioneurotic oedema (allergic response where skin and larynx swell up- rare but life threatening), first dose hypotension, renal impairment, dry cough (use angiotensin receptor blocker instead (losartan) ```

Question 37

how do angiotensin II receptor blockers work

Answer 37

stop angiotensin II binding to its receptor

Question 38

what do all angiotensin II receptor blockers end in (give 2 examples)

Answer 38

ARTAN: losartan and valsartan

Question 39

why must beta blockers be used with caution in CCF

Answer 39

as can worsen in short term- start low dose, increase slowly

Question 40

what are the initial risks of beta blockers in beta blockers

Answer 40

hypotension and worsening dysponoea

Question 41

what do beta blockers end in and give examples of two used in CCF

Answer 41

bisoprolol (B1 selective) and carvedilol (non selective)

Question 42

what is spironolactone

Answer 42

aldosterone receptor antagonist

Question 43

what does aldosterone do

Answer 43

causes water to be re absorbed

Question 44

in what severity of CCF should spironolactone be used

Answer 44

moderate/ severe

Question 45

what are the side effects of sprionolactone

Answer 45

hyperkalaemia (increased potassium), renal dysfunction, gynaecomastia (breast growth by disruption of male sex hormones)

Question 46

what is ivabradine and when is it used in CCF

Answer 46

slows heart rate, only used when heart failure is not fully managed with beta blockers

Question 47

what is sacubitril-valsartan

Answer 47

combination of ARB (valsartan) and neprilysin inhibitor (sacubitril)

Question 48

what does a neprilysin inhibitor do

Answer 48

blocks natriuretic peptide breakdown and boosts natriuretic peptide (BNP) levels

Question 49

what does sacubitril- valsartan do in heart failure and in what severity of CCF should it be used

Answer 49

replaces ACE inhibitors in severe heart failure MUST NOT BE USED ALONG WITH AN ACE INHIBITOR

Question 50

What does cardiac resynchronisation therapy do and in what type of CCF

Answer 50

to make right and left sides contract at the same time- only for prolonged QRS- 3 pacemakers inserted to force LV and RV to contract together

Question 51

what causes the left and right ventricles to contract at different times

Answer 51

bundle branch block- long QRS

Question 52

why does digoxin have narrow therapeutic threshold

Answer 52

as excreted slowly by kidneys- 1/3 each day, builds up

Question 53

what is digoxin used in and its efficiency in both

Answer 53

excellent therapy for AF mediocre therapy for CCF IN SINUS RHYTHM ONLY

Question 54

what are the side effects of digoxin

Answer 54

nausea, vomiting, bradycardia, heart block (atria and ventricles contracting independently), arrhythmia

Question 55

how does digoxin work

Answer 55

AV block

Question 56

what are the acute therapies of acute LVF therapy

Answer 56

sit up- gets fluid away from the lungs oxygen intravenous furosemide (lasix) (loop diuretics) intravenous diamorphine (not in COPD) (intravenous nitrates can be used in angina)