Heart failure

Question 1

What is heart failure (HF)

Answer 1

Inability to provide adequate cardiac output to support the needs of the tissues

Question 2

What is a normal cardiac output (l/min)

Answer 2

8 l/min

Question 3

What happens to the muscle layer in the house in congestive heart failure

Answer 3

In compensated heart failure you get compensatory hypertrophy in which you get new muscle, but with a different structure therefore is unsustainable. Caused by increased load on the heart increasing wall stress (same as muscular effort) causing hypertrophy

Question 4

What are the two types of cardiomyopathy?

Answer 4

Hypertrophic and dilated

Question 5

What medications can be given to slow the progression of congestive heart failure?

Answer 5

Beta blockers - deal with increased sympathetic activation due to baroreceptor reflex
ACE inhibitors - deal renin angiotensin system
Spironolactone - deals with aldosterone secretion (aldosterone causes water + Na reabsorption)

Question 6

What is the New York classification of heart failure?

Answer 6

I - heart disease present, no undue dyspnoea
II - comforable at rest, dyspnoea during ordinary activities
III - less than ordinary activity causes dyspnoea, limiting
IV - dyspnoea present at rest, all activity causes discomfort

Question 7

How do you treat heart failure?

Answer 7

1) Lifestyle modifications
2) Aldosterone agonists (like spironolactone) lower BP
3) Afro-Carribean patients, give hydralizine or nitrates
4) Ivabradine - slows HR
5) Digoxin if in AF
6) Loop diuretics (eg furosemide)
7) ACE inhibitors + beta blockers (if ineffective) use angiotensin receptor blocker (ARB)

6+7 reduce BP

Question 8

What are the causes of systolic heart failure

Answer 8

Ischaemic heart disease
Sarcoidosis
Haemochromatosis
Dilated cardiomyopathy
Myocarditis

Question 9

What are the causes of diastolic heart failure

Answer 9

Hypertrophic obstructive cardiomyopathy
Restrictive cardiomyopathy
Cardiac tamponade
Constrictive pericarditis