Heart Failure

Question 1

What is left CCF mainly due to?

Answer 1

IHD (MIs)
Cardiomyopathy
Valvular disease

Question 2

What is right CCF mainly due to?

Answer 2

secondary to LHF
cor pulmonale
congenital heart disease

Question 3

Symptoms of LVF?

Answer 3

dyspnoea (exertion/rest)
orthopnoea
paroxysmal nocturnal dyspnoea
pulmonary oedema

Question 4

Signs of LVF?

Answer 4

displaced apex
pan systolic murmur
tachycardia
fine crepitations
pleural effusion
S3

Question 5

What might a CXR of LVF show?

Answer 5

cardiomegaly
bats wing shadows esp. lower zones
interstitial fluid

Question 6

What are signs of pulmonary embolism?

Answer 6

sunken dyspnoea

pink, frothy sputum

Question 7

What murmur is assoc. with LVF?

Answer 7

pan systolic = functional mitral regurgitation

Question 8

What heart sound is assoc. with LVF?

Answer 8

S3 = gallop rhythm due to rapid ventricular filling

Question 9

Symptoms of RHF?

Answer 9

oedema

Question 10

Signs of RHF?

Answer 10

ankle/sacral oedema
JVP elevated
hepatomegaly
ascites

Question 11

What would you see on a CXR of RHF?

Answer 11

nothing, it good normal

Question 12

How do you treat CCF due to previous MI or cardiomyopathy?

Answer 12

(standard medical treatment for CCF)
Diuretics
ACE inhibitors
B-blockers
Spironolactone
Digoxin

Question 13

What are the signs of interstitial fluid on CXR?

Answer 13

Kerley B lines

Question 14

How do you treat CCF due to cor pulmonale?

Answer 14

Diuretics and O2 only:

e.g. furosemide (would also need K+ supplements) or spironolactone or ACE-I

Question 15

What is the ideal therapy for CCF due to valvular disease?

Answer 15

surgery

Question 16

How do you treat CCF due to fast AF?

Answer 16

digoxin or DC shock

Question 17

Which diuretics help retain and normalise K+ concentration?

Answer 17

ACE inhibitors and spironolactone

Question 18

Which type of diuretic would you use in mild CCF?

Answer 18

thiazide like diuretics

Question 19

What are some of the side effects of ACE-Is?

Answer 19

angioneurmtic oedema
1st dose hypertension esp. if serum Na+ low
renal impairment
COUGH

Question 20

Which drugs can be used instead of ACE-Is?

Answer 20

Angiotensin II receptor blockers

Question 21

Give examples of ARBs

Answer 21

Losartan and Valsartan

Question 22

What are the initial risks of using b-blockers in CCF?

Answer 22

worsening SOB

hypotension

Question 23

Which receptor does spironolactone act on?

Answer 23

aldosterone receptor antagonist

Question 24

What are some side effects of spironolactone?

Answer 24

hyperkalaemia
renal dysfunction
gynaecomastia

Question 25

How does Ivabradine work and when would you use it?

Answer 25

blocks the pacemaker ‘funny current’
slow HR
only use if HR fast despite b-blocers

Question 26

What are the steps of acute LVF therapy?

Answer 26

1. Sit up patient
2. O2 if hypoxic
3. IV furosemide
4. IV diamorphine

Question 27

What is a biomarker for heart failure?

Answer 27

BNP
increased BNP distinguishes heart failure from other types of SOB
rises are greater with left over right sided, and with systolic over diastolic dysfunction

Question 28

What is the role of ANP and BNP?

Answer 28

assist stretched atria and ventricles - reduce fluid load - relax SM - decrease preload.