Heart Failure

Question 1

List some of the RF of LEFT Heart Failure

Answer 1

Valvular disease - Aortic R, Aortic S, Mitral R (Left valves)
Pump failure: IHD, MI, Cardiomyopathy, Myocarditis, AF
Systemic: Hypertension, Amyloidosis
Drugs: Alcohol, Cocaine

Question 2

List some of the RF of RIGHT Heart Failure

Answer 2

Lungs: Pulmonary hypertension, Pulmonary embolus, Pulmonary valve disease, Chronic lung disease - pulmonary fibrosis, COPD

Valvular disease: Tricuspid regurgitation, pulmonary valve disease

LHF

Question 3

List high output RF for Heart Failure

Answer 3

Nutritional deficiency - B12/Thiamine deficiency
Anaemia
Pregnancy

Malignancy - Multiple Myeloma
Endocrine - Hyperthyroid
AV malformation
Liver Cirrhosis
Sepsis

Question 4

List the signs and symptoms of LHF

Answer 4

Respiratory symptoms - 
Extertional dyspnoea
Orthopnoea
Paroxysmal nocturnal dyspnoea
Fatigue
Night coughs with pink frothy sputum
Wheeze
Tachycardia
Increased respiratory rate
Displaced apex beat
S3
AS, MR
Bibasal crackles

Question 5

List the signs and symptoms of RHF

Answer 5

Swelling - ankles, face, abdomen 
Fatigue
Weight gain (oedema)
Reduced exercise tolerance
Anorexia
Nocturia
Nausea

Signs: Raised JVP
Facial swelling
Parasternal heave
TR murmur
Tachycardic
Tachypnoea
Ascites
Hepatomegaly
Pitting edema in ankles, sacrum

Question 6

List the Ix for Heart Failure

Answer 6

Bedside history and examination
ECG

Bloods
FBC - anaemia can cause HF
U&Es
LFTs
TFTs - Hyperthyroid can cause HF
gluose - DM is RF for heart failure
BNP - high negative predictive value

Imaging
Transthoracic echocardiogram
CXR

Question 7

What is ejection fraction?

Answer 7

SV/EDV

Question 8

What is a normal Ejection fraction?

Answer 8

50-70%

Question 9

What is the ejection fraction in systolic heart failure?

Answer 9

<40%

Question 10

What signs do you expect to see in a CXR for patient with HF?

Answer 10

Alveolar oedema
B-lines (Kerley B lines - interstital oedema)
Cardiomegaly - batwing apperance of the heart
Dilated upper lobe vessels
Effusion (pleural)

Question 11

What is the management for chronic congestive heart failure?

Answer 11

Treat underlying cause

ACE inhibitors - Captopril, Enalapril
Lifestyle modification: Sodium restriction, fluid restriction, Weight monitoring, Continuous health screening, exercise training
Beta-blocker - carevedilol, metoprolol, brisoprolol

Question 12

What is the management for a patient presenting with acute heart failure?

Answer 12

Sit upright 
O2 (aim for SpO2: 94-98%)
IV access and ECG
Diuretics - IV furosemide
Vasodilators - GTN spray sublingual
Analgeisa 

(if due to cardiac ischaemia - aspirin + revascularisation)
So I Don’t Vant Anna (think of a Russian accent)

Question 13

Complications of Heart Failure?

Answer 13

DRAP

Death
Renal failure
Acute exacerbations
Pleural effusion