Heart Failure

Question 1

Heart failure can be HFPEF or _______ which means ____________

Answer 1

Diastolic- heart failure with preserved ejection fraction
the heart muscle contract normally but does not fully relax so the volume of blood filling the cavity is reduced so SV is reduced

Question 2

Heart failure can be HFREF or _______

which means __________

Answer 2

Systolic- heart failure with reduced ejection fraction

the heart has reduced ability to pump or eject the blood

Question 3

3 main causes of heart failure?

Answer 3

ischaemic heart disease, cardiomyopathy (dilated) and hypertension

Question 4

Patient will complain of?

Answer 4

SOB, orthopnoea, paroxysmal nocturnal dyspnoea, reduced exercise tolerance and fatigue.

Question 5

On examination

Answer 5

Ankle swelling, sacral oedema, elevated JVP, bi-basal crackles, 3rd and 4th heart sounds, pleural effusion, tender hepatomegaly.

Question 6

Investigations

Answer 6

On CXR enlarged cardiac silhouette with evidence of fluid accumulation in the lungs
ECG done to confirm past MIs, arrhythmias and left ventricular hypertrophy
Echo is good but long waiting time
BNP testing is good and very sensitive
MRI if scarring or potentially reversible hibernating myocardium

Question 7

Lifestyle advice for heart failure management?

Answer 7

Advice on diet and salt intake
Fluid restrictions
Stop smoking
Exercise
Vaccinations up to date

Question 8

Drug management for heart failure

Answer 8

Diuretics to improve symptoms (furosemide)
Digoxin for symtoms

For improved survival:
ACE inhibitors (ARBS if not tolerated)
Beta blockers- bisoprolol
Aldosterone antagonists- spironolactone
Vasodilators
Ivabradine

Question 9

Most heart failure is right or left sided?

Answer 9

left sided

Question 10

Main cause of left sided heart failure?

Answer 10

ischaemic heart disease

Question 11

Where does fluid build up in left vs right sided heart failure?

Answer 11

• In left sided heart failure fluid builds up in the lungs as the backed up blood places pressure on the pulmonary arteries which then forces fluid out
• In right sided heart failure fluid backs up in the body resulting in jugular venous distension, hepatosplenomegaly, ascites, pitting oedema (generally in the legs and sacrum due to gravity)

Question 12

Heart failure caused by lung failure is referred to as?

Answer 12

Cor pulmonale

Question 13

Explain why you get fluid retention in left sided heart failure?

Answer 13

Less blood from heart > Sensed by kidneys > Activation of RAAS > Fluid retention > increased filling and preload > temporary increase in contraction strength

Although initially this compensation mechanism works long term this increasing fluid leaks from vessels, you get fluid buildup in the lungs and then this worsens the symptoms of heart failure

There is also fluid buildup in the lungs because the failing left side of the heart means blood backs up in the lungs, the results in increased pulmonary artery pressure and this pushes fluid out into the tissue

Question 14

Causes of right sided heart failure?

Answer 14

• Right sided heart failure is often caused by left sided heart failure (as LHF causes increased PA pressure which makes it harder for the right side to pump)
• There are however some isolated causes of right sided heart failure including pulmonary hypertension, lung disease, congenital diseases