Heart Failure

Question 1

d: heart failure

Answer 1

the state in which the heart cannot pump efficiently

Question 2

Name the causes of HF in UK

Answer 2

Coronary Heart disease +/- MI
Hypertension
dilated cardiomyopathy
-patients with no obvs causes family history important
valve disease
tachycardic arrythmias
HEFpEF

Question 3

Name the most common valve diseases in the elderly?

Answer 3

aortic stenosis

Question 4

What is the SAS response?

Answer 4

Phone the nearest PCI centre (Dundee)
Relayed ECG  
Activates a PPCI Team
Immediate treatment
GTN s/l
Aspirin 300mg oral
Clopidogrel 600 mg
Heparin 5000 U iv
Oxygen via  mask
Rapid transport to the activated PCI centre
Go straight to the cath lab

Question 5

How is the patient managed in CCU?

Answer 5

Phone the nearest PCI centre (Dundee)
Relayed ECG  
Activates a PPCI Team
Immediate treatment
GTN s/l
Aspirin 300mg oral
Clopidogrel 600 mg
Heparin 5000 U iv
Oxygen via  mask
Rapid transport to the activated PCI centre
Go straight to the cath lab

Question 6

What are the Classic symptoms of HF?

Answer 6

Shortness of breath
Difficulty breathing at night when recumbent
Orthopnoea
Paroxysmal nocturnal dyspnoea
Reduced exercise tolerance
Fatigue
Tiredness
Ankle swelling

Question 7

What are common Left sided diseases leading to heart failure?

Answer 7

IHD : MIs cardiomyopathy

valvular disease

Question 8

What are right sided heart diseases that are secondary to left heart failure?

Answer 8

cor pulmonale

congenital heart disease

Question 9

if you have HF what will your pulse do and what is this called?

Answer 9

Pulsas Alternans (pulse will alternate weak and strong beats)

Question 10

can you have a combination of left and right heart failure?

Answer 10

yes

Question 11

symptoms of LVF?

Answer 11

Dyspnoea on exertion/rest, orthopnoea, Paroxysmal Nocturnal Dyspnoea, Pulmonary oedema

Question 12

clinical signs of LVF?

Answer 12

tachycardia, fine crepitation, pleural effusion, 3rd heart sound

Question 13

CXR of LVF?

Answer 13

cardiomegaly, bat wings, interstitial fluid

Question 14

common symptom of RVF?

Answer 14

oedema

Question 15

clinical signs of RVF?

Answer 15

oedema (ankle/sacral), JVP elevated, hepatomegaly, Ascites

Question 16

what will the CXR show for RVF?

Answer 16

nothing it will be normal

Question 17

HF is aka

Answer 17

congestive cardiac failure CCF

Question 18

Causes of CCF?

Answer 18

Previous MI, Cardiomyopathies.
Cor pulmonale – diuretics + oxygen,
Valvular disease – surgery,
Fast AF – Digoxin or DC Shock.

Question 19

Name the standard treatment for CCF? HOW DELIVERED?

Answer 19

Diuretics (loop to relieve symptoms [increase dose OR add spironolactone])
2. ACEi (1st line with B-Blocker if LVF, replace with ARB if cough)
3. B-Blockers (calso Ivabradine (only if HR too fast despite B-Blockers)
4. Spironolactone (if symptomatic despite optimum therapy)
5. Digoxin
6. Other Vasodilators (nitrates + hydralazine IF intolerant to ACEi + ARBs)
Implantable Cardiac Defibrillators
Cardiac resynchronisation therapy
Transplantation

Question 20

what is the std treatment for acute HF?

Answer 20

• Treat any arrhythmias
• Diamorphine IV
• IV furosemide
• GTN

Question 21

why is the patient given diuretics?

Answer 21

to excrete retained fluid

Question 22

if the patient has refractory oedema what do you give them instead of diuretics and why?

Answer 22

oedema resistant to diuretics] add thiazide

Question 23

when is the patient given ivabradine?

Answer 23

only if HR too fast despite B-Blockers

Question 24

what is a side effect of spironolactone?

Answer 24

gynocomastia

Question 25

What is digoxin only good for? ans what isnt it good for?

Answer 25

only good for AF, not for CCF in sinus

Question 26

When is cardiac resynchronisation therapy allowed?

Answer 26

only for prolonged qrs