Heart failure

Question 1

what is heart failure

Answer 1

heart unable to pump blood at rate in keeping with tissue requirements 1

Question 2

what is impaired ventricular filling

Answer 2

lack of ventricular relaxation so less blood fills into heart - reduced SV

Question 3

what is impaired blood ejection

Answer 3

less blood pumped out due to impaired ventricular wall

Question 4

causes of heart failure

Answer 4

CHD +/- MI
Hypertension/diabetes
Dilated cardiomyopathy 
Valve disease 
tachyarrhythmia

Question 5

what would ECG find in heart failure

Answer 5

LVH
Past MI
Arrhythmia

Question 6

gold standard in diagnosing heart failure

Answer 6

Echocardiography

screens for function, filling, valves, ejection fraction

Question 7

what blood test can mark heart failure

Answer 7

BNP

Question 8

cardiac MRI reveals <50% scarring on myocardium. can PCI be done?

Answer 8

yes, cannot if >50% scarring

Question 9

what is HFrEF

Answer 9

heart failure with EF <40%

Question 10

what is HFpEF

Answer 10

heart failure with normal EF

Question 11

what is a normal ejection volume

Answer 11

> 50%

Question 12

what lifestyle changes can be made to manage heart failure

Answer 12

Exercise therapy
Reduce salt intake
fluid and water restriction
treat possible depression

Question 13

what 2 drugs improve heart failure symptoms

Answer 13

frusemide

digoxin

Question 14

drugs used to prolong survival of heart failure

Answer 14

ACEI/ARB - first line, max dose
B-blockers - low dose
Spironolactone 
Nitrates if ACEI/ARB not tolerated 
Ivabradine next line

Question 15

where would you consider pacing in heart failure

Answer 15

in LBBB

Question 16

what is the treatment of HFpEF

Answer 16

nothing, only exercise

Question 17

what does SGLT2 inhibitors do?

Answer 17

lower blood glucose by excretion via urine

Question 18

what controls blood flow to capillaries

Answer 18

arterioles and in some tissues pre capillary sphincters

Question 19

what transport are exchangeable proteins moved by

Answer 19

vesicular transport

Question 20

what proteins cannot cross the capillary wall?

Answer 20

plasma proteins

Question 21

true/false - transcapillary fluid flow is driven by concentration gradient

Answer 21

false- driven by pressure gradients

Question 22

what is ultra filtration

Answer 22

exchange of fluids across capillary wall free of plasma protein

Question 23

NFP = ?

Answer 23

forces favouring filtration - forces opposing filtration

Question 24

forces favouring filtration and their pressures

Answer 24

capillary hydrostatic pressure - 35 mmHg arterial and 17 mmHg venule
interstitial fluid osmotic pressure - 1 mmHg

Question 25

forces opposing filtration and their pressures

Answer 25

capillary osmotic pressure - 25mmHg

interstitial fluid hydrostatic pressure 1 mmHg

Question 26

describe fluid flow across capillary walls

Answer 26

flow outwards at arterial end and inwards at venule end

Question 27

how do the lungs prevent fluid accumulation

Answer 27

low capillary hydrostatic pressure and high capillary osmotic pressure

Question 28

what is oedema

Answer 28

fluid accumulation in interstitial space

Question 29

causes of oedema

Answer 29

raised capillary pressure
lymphatic insufficiency
reduced plasma osmotic pressure
change in capillary permeability

Question 30

what is the nomal osmotic plasma pressure and how is this reduced in oedema

Answer 30

normal 65-80 g/l
oedema <30 g/l
may be malnutrition, excessive renal excretion

Question 31

how would pulmonary oedema be picked up?

Answer 31

crepitation in lung bases

CXR - haziness in perihilar region - bat wing shape and kerley B lines