Heart Failure

Question 1

What is heart failure?

Answer 1

the state in which the heart is unable to pump blood at a rate commensurate with the requirements of the tissues or can do so only at high pressures

Question 2

What are the 2 main reasons for heart failure?

Answer 2

impairment of ventricular filling

impaired ejection of blood

Question 3

What is the effect impaired left ventricular filling?

Answer 3

In diastole, the left ventricle (LV) walls relax allowing for filling of the LV cavity
Without proper LV relaxation, the volume of blood filling the cavity is reduced, thus reducing the stroke volume, the volume of blood ejected with each contraction

Question 4

What is the main reason for an impaired ejection of blood?

Answer 4

LV wall damage

Question 5

What are the classic symptoms of heart failure?

Answer 5

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

Question 6

What are the signs of the physical exam which indicate cardiac failure?

Answer 6

• raised JVP
• crackles at the lung bases
• 3rd or 4th heart sound (gallop rhythm)
• murmur
• sacrum oedema
• oedema in the feet ankles and lower legs

Question 7

What blood test is used to diagnose ventricular failure?

Answer 7

The BNP blood test

Question 8

What is the determinant of viable and non-viable myocardium?

Answer 8

Whether the scar tissues exceeds 50% of the myocardium

Question 9

What are the signs of Right Sided heart failure?

Answer 9

Raised JVP
Pitting Oedema (ankles and sarcum)
Hepatic congestion

Question 10

How do you treat acute heart failure?

Answer 10

LMNOP
Lasix (furosemide)
Morphine 
Nitrates
O2
Position

Question 11

What are the side effects of ACE inhibitors?

Answer 11

dry cough, if they get a cough give ARB

Question 12

What is the heart failure ‘holy trinity’?

Answer 12

ACE inhibitors
B blockers
Spironolactone