Heart Failure

Question 1

Symptoms of LEFT heart failure:

Answer 1

Shortness of breath
Orthopnoea
Pink frothy sputum

Fine crackles, pleural effusion, 3rd heart sound.

Question 2

Symptoms signs of RIGHT heart failure:

Answer 2

Peripheral oedema, raised JVP, hepatomegaly, ascites.

Question 3

Investigation of heart failure?

Answer 3

BNP!! (B natriuretic peptide) = released when ventricles are stretched.

• If <100, heart failure is unlikely
• If BNP raised or abnormal ECG&raquo_space;> ECHO

Question 4

Management of heart failure?

Answer 4

1st line - ACE I and Beta blocker (bisoprolol, carvedilol)

2nd line = spironolactone, ARB (e.g. candesartan) or hydralazine in combination with a nitrate

If symptoms persist then = digoxin or cardiac resynchronisation therapy

Diuretics e.g. furosemide if fluid overload.

Question 5

Last line?

Answer 5

Cardiac desynchronisation, digoxin, or ivabradine.