Heart failure

Question 1

Describe systolic and diastolic HF

Answer 1

Systolic - ventricle unable to contract -> reduced CO, EF <40%
Diastolic - ventricle unable to relax and fill, causing increased filling pressure, EF >50%

Question 2

What are the causes of systolic HF

Answer 2

IHD
MI
Cardiomyopathy

Question 3

What are the causes of diastolic HF

Answer 3

Constrictive pericarditis
tamponade
HTN

Question 4

What are the sx of LVHF

Answer 4

SOB
poor exercise tolerance 
Fatigue
Orthopnoea 
PND
productive cough - pink frothy sputum
wheeze
nocturia
cold peripheries
Weight loss + muscle wasting

Question 5

What are the sx of RVHF

Answer 5

Peripheral oedema 
Ascites
N+V
Anorexia
epistaxis

Question 6

what are the causes of RVHF

Answer 6

LVF
Pulmonary stenosis
lung disease

Question 7

When RVHF and LVHF occur together what is this known as?

Answer 7

congestive cardiac failure

Question 8

What is the difference between acute and chronic HF

Answer 8

acute - new onset or decompensation of chronic HF

chronic - slow progression, arterial pressure maintained until v late

Question 9

What are the signs of acute hf

Answer 9

pulmonary and peripheral oedema +/- signs of peripheral hypoperfusion

Question 10

What are the causes of low output HF

Answer 10

1. pump failure:
   - systolic/diastolic hf
   - reduced HR
   - -ve inotropic
2. Excessive preload:
   - mitral regurg
   - fluid overload
3. Chronic excessive after load:
   - aortic stenosis
   - HTN

Question 11

What are the causes of high output HF

Answer 11

essentially due to increased needs, examples that cause this include anaemia, pregnancy and hyperthyroidism

Question 12

What are signs + sx of chronic HF

Answer 12

orthopnoea, SOB, PND, ankle oedema, wheeze, bibasal crackles, weight loss (cardiac cachexia), cough w pink sputum,

Question 13

What are the signs and sx of acute HF

Answer 13

tachycardia, SOB, displaced apex beat, oedema, cyanosis, S3 HS, fatigue, raised JVP, reduced ETT

Question 14

Describe the NYHA classification of HF

Answer 14

I - no sx, no limitations
II - mild, slight limitation on activity
III - marked limitation on activity, some at rest
IV - severe limitation, sx at rest, mostly bed bound

Question 15

what are the investigations for HF

Answer 15

1. CXR
2. ECG - may indicate cause
3. FBC, U+E (renal function)
4. NT-proBNP
5. ECHO -confirms LV dysfunction

Question 16

What would u see on CXR in HF

Answer 16

• Cardiomegaly
• kerley b lines
• pulmonary congestion
• upper zone vessel enlargement
• blunt costophrenic angles

Question 17

what is NT-proBNP? what levels indicate: 
i. unlikely HF
ii. raised
iii. high 
what actions would you take for each?

Answer 17

hormone produced by LV myocardium in response to strain

i. <400
ii. 400-2000 - assess and echo in 6 weeks
iii. >2000 - assess and echo in 2 weeks

Question 18

What are the causes of raised BNP

Answer 18

> 70yrs, LV hypertrophy, ischaemia, tachycardia, hypoxaemia, sepsis, COPD, DM, eGFR

Question 19

What are the causes of low BNP

Answer 19

obesity, afro-caribbean, diuretics, ACEi, BBs, ARBs, aldosterone antagonists

Question 20

What is the management of HF with reduced EF

Answer 20

• diuretics
• CCBs
• ACEi + BB
• MRA (spironolactone) if sx continue

Question 21

What should be routinely monitored for those being treated for HF?

Answer 21

Functional capacity, fluid status, cardiac rhythm, cognitive and nutritional status, review of meds, renal function

Question 22

What can precipitate acute hf?

Answer 22

• ACS
• Hypertensive crisis
• Acute arrhythmia
• Valvular disease

Question 23

What rules out a diagnosis of acute HF?

Answer 23

BNP <100
or
NT-proBNP <300

Question 24

What is the management of acute HF?

Answer 24

1. Diuretics
2. Monitor renal function, weight and UO
3. Continue BBs if on unless HR <50, 2nd/3rd HB, or shock
4. Offer ACEi + aldosterone antagonist