Heart Failure

Question 1

Heart failure

Answer 1

Failure of the heart as a pump to meet the circulatory needs

Question 2

Names of heart failure

Answer 2

Chronic
Congestive heart failure
Congestive cardiac failure

Question 3

What may heart failure be caused by ?

Answer 3

Failure of the heart muscle or failure of the heart valves

Question 4

Characteristic of heart failure

Answer 4

Chronic or acute (post MI)

Secondary: IHD (Ischaemic heart disease, hypertension, cardiomyopathies (alcohol viral )

Question 5

What is heart failure precipitated by?

Answer 5

Pregnancy
Anaemia
Hyper/hypothyroidism
Fluid retaining drugs - glucocorticoids, NSAIDs

Question 6

How can valvular heart failure be treated?

Answer 6

Easily - surgery

Question 7

What can chronic heart failure be a consequence of?

Answer 7

MI

Question 8

What is cardiac function governed by?

Answer 8

Preload, afterload and muscle contractility

Question 9

What is impaired muscle function usually caused by?

Answer 9

Ischaemic heart disease

Question 10

How does hypertension contribute to heart failure?

Answer 10

Cardiac enlargement increased work of the heart and lessens ejection fraction

Question 11

What can cause hypertrophy

Answer 11

Increased afterload - hypertrophy

Question 12

How does the body try to compensate for circulatory failure?

Answer 12

Neurohormonal adaptation, activation of:
Sympathetic nervous system 
Renin-angiotensin-aldosterone system
ADH
Atrial natriuretic peptide (ANP)

Question 13

Which adaptations cause heart failure to be worse?

Answer 13

Activation of

SNS, RAA, ADH

Question 14

What is ANP

Answer 14

Atrial Natruiretic Peptide
Released by failing atria
Acts on kidney, promotes excretion of Na
Positive effect on circulatory system - circulatory volume increases

Question 15

What does angiotensin II do?

Answer 15

Increases blood pressure - vasoconstriction and Na retention
Acts on adrenal gland to produce aldosterone

Question 16

How does RAA make things worse?

Answer 16

Increased resistance - impaired renal function, more salt/water retention with further activation of RAA system
Increased fluid
Increased after load
Further impairs pump activity of the heart
Leads to myocyte dysfunction

Question 17

Describe left-sided failure

Answer 17

Often secondary to hypertension

LV impaired, leads to increase in left atrial/pulmonary venous pressure with pulmonary oedema

Question 18

What is pulmonary oedema?

Answer 18

Accumulation of fluid in the tissue of the lungs

Leads to swelling

Question 19

How does an oedema form?

Answer 19

Increased venous pressure,opposes reabsorption of fluid

Fluid accumulates in the tissues

Question 20

Describe right-sided heart failure

Answer 20

RV output fails

Often due to lung disease, pulmonary valvular stenosis

Question 21

Describe biventricular failure

Answer 21

Both chambers
Disease (IHD) has affected both ventricles
LVF leads to pulmonary congestion, may lead to RVF

Question 22

Signs and symptoms of heart failure

Answer 22

Fatigue, listless
Poor exercise tolerance (determines grade)
Cold peripheries - vasoconstriction 
Low blood pressure?
Reduced urine flow
Weight loss

Question 23

LV failure signs and symptoms

Answer 23

Pulmonary oedema
Dyspnoea – sensation of drowning
‘Cardiac asthma’
Cough - wet 
Orthopnoea
Nocturnal problem? (paxosysmal nocturnal dyspnoea)
Inspiratory crepitations

Question 24

RV failure signs and symptoms

Answer 24

Raised venous pressure
Increased JVP
Enlarged liver
Oedema – ankles; if lying down rises to thighs/abdomen

Question 25

Why does Orthopnoea occur?

Answer 25

Lying down promotes venous return which causes oedema

Question 26

Upon auscultation what would you hear if there is LV failure?
And why?

Answer 26

Crackles

Pulmonary oedema

Question 27

How to diagnose heart failure

Answer 27

Symptoms
Examination
Echocardiogram - ejection fraction <45%
B-type natriuretic peptide (BNP)
Chest x-ray

Question 28

In right ventricle failure why is the oedema in ankles?

Answer 28

Gravity

Question 29

What is an echocardiogram?

Answer 29

Ultrasound of the heart

Question 30

How is B-type natriuretic peptide (BNP) used to diagnose heart failure?

Answer 30

Blood test
Elevated levels means heart failure
Released by failing ventricles - to act on kidneys to excrete Na

Question 31

How to determine on chest x-ray is there is heart failure?

Answer 31

Enlargement of heart (50% bigger -cardiothoracic thing)
Pulmonary oedema - fluffy
Pronounced lymphatic vessels

Question 32

What can LV failure lead to ?

Answer 32

/valve failure
Increased pressure in left atria
Leading to distension, leading to AF
AF (stasis of blood), leads to thrombus which may dislodge and move to cerebral circulation

Question 33

How to treat LV failure leading to Af to stroke

Answer 33

Prophylaxis, warfarin, DOACs

Question 34

Prognosis of chronic heart failure

Answer 34

Depends on stage: 1 = no symptoms 4 = breathless at rest
Poor
Median survival rate of mild/moderate failure of 5 years

Question 35

Goals of treatment

Answer 35

Identify / treat any cause (valvular disease; IHD)
Reduce cardiac workload
Increase cardiac output
Counteract maladaptation
Relieve symptoms
Prolong quality life – reduce hospitalisation