Heart failure

Question 1

what is heart failure

Answer 1

the inability of the heart to adequately perfuse tissue

Question 2

what is the main cause of HF

Answer 2

heart can’t pump so low CO, body retains fluid causing overload, heart then has to work harder as more fluid and resistance

Question 3

what is the main cause of left sided HF

Answer 3

ischaemic heart disease, cardiomyopathies, valvular disease, MI

Question 4

how do MI’s lead to HF

Answer 4

reduced contractility from scar tissue leads to low CO

Question 5

what are main symptoms of left sided HF

Answer 5

SOB on exertion/ rest. Orthopnea, pink, frothy sputum (pulmonary oedema)

Question 6

what are main signs of left sided HF

Answer 6

tachycardia, crepirations, pleural effusion, SX, bats wings on CXR, 3rd heart sound

Question 7

what are main causes of right sided HF

Answer 7

secondary to left sided HF, cor pulmonale and congenital defects

Question 8

how does cor pulmonale cause HF

Answer 8

lung disease causes hypoxia, causing vasoconstriction which increases pressure back to heart, meaning its has to work harder.

Question 9

what are the main signs and signals of right sided HF

Answer 9

ankle swelling, raised JVP, ascites

Question 10

how does left ventricular failure cause pulmonary oedema

Answer 10

LV failure causes LA pressure to rise which causes pressure to lungs to increase. this increases capillary hydrostatic pressure (fluid isn’t . absorbed into vessels and stays in lungs) causing fluid to accumulate in pleural space.

Question 11

what investigations can be done for HF

Answer 11

transthoracic echo (TTE) is best. CXR, ECG

Question 12

what drug treatment is used

Answer 12

diuretics, ACEi, B blockers, spironolactone, digoxin

Question 13

what invasive therapy can be done for HF

Answer 13

pacemakers, cardiac resynch therapy

Question 14

what is the ejection fraction (EF)

Answer 14

the % of blood present in the heart that is ejected

Question 15

what is a normal EF

Answer 15

> 50%

Question 16

what does HF with reduced EF show

Answer 16

EF less than 40%. ‘heart failure with reduced ejection fraction (HFrEF). shows LV can’t eject properly

Question 17

what does HF show with normal EF

Answer 17

‘heart failure with preserved ejection fraction)’ HFpEF. less blood fills.

Question 18

what treatment can be done for HF (not meds)

Answer 18

low salt and water, pacemaker, cardiac resynch

Question 19

what medications can be given for HF

Answer 19

if pulmonary oedema loop diuretics eg foresumide, for treatment ACEi + B blockers, thiazides in mild, spironoloactone, nitrates, ivabradine