Heart Failure

Question 1

What are the salt and water restrictions advised to patients with heart failure?

Answer 1

< 6g of salt per day, < 1.5L of water per day

Question 2

Which type of heart failure will respond to drugs which prolong survival in heart failure?

Answer 2

HFREF

Question 3

Name some drug classes which can be used to prolong survival in patients with heart failure?

Answer 3

ACE inhibitors/ARBs, beta blockers, spironolactone, vasodilators

Question 4

Name some drug classes which can be used to improve symptoms in patient with heart failure?

Answer 4

Diuretics, digoxin and beta blockers

Question 5

How should beta blockers be started in heart failure and why?

Answer 5

They should be started at a low dose and increased slowly, as they may worsen heart failure in the short-term

Question 6

In which type of heart failure (i.e. left or right) may a CXR be normal?

Answer 6

Right sided

Question 7

What are some signs which may be seen on a CXR of heart failure?

Answer 7

Kerley B lines, ill-defined peri-hilar shadowing, pleural effusions, increased cardiothoracic ratio

Question 8

What is the single most useful diagnostic test for heart failure?

Answer 8

Transthoracic ECHO

Question 9

What blood test is a useful rule out test in patients who have symptoms of heart failure?

Answer 9

BNP

Question 10

In addition to those which are necessary, what are some further investigations which may be useful in patients with heart failure?

Answer 10

Cardiopulmonary exercise tests, coronary angiography, cardiac MRI

Question 11

What are some symptoms and signs of pulmonary oedema which may occur in someone with left sided heart failure?

Answer 11

Tachycardia, dyspnoea, fine crepitations/crackles at the lung bases, pleural effusions

Question 12

A ‘gallop rhythm’ may be heard on auscultation of somebody with left sided heart failure. What is this?

Answer 12

Tachycardia and a 3rd heart sound

Question 13

What type of sputum will somebody who has pulmonary oedema as a result of left sided heart failure produce?

Answer 13

Pink, frothy sputum

Question 14

What investigations must all individuals who present with symptoms/signs of heart failure have?

Answer 14

ECG, CXR, bloods, ECHO

Question 15

What is a second line drug which is used frequently in the management of moderate-severe heart failure?

Answer 15

Spironolactone

Question 16

What is the only curative option in the treatment of heart failure?

Answer 16

Heart transplant

Question 17

How should you position patients in acute heart failure?

Answer 17

Sit them upright

Question 18

Describe the drugs used in the initial management of acute heart failure?

Answer 18

IV furosemide, morphine and GTN

Question 19

What is the first line therapy to improve prognosis in patients with HFREF?

Answer 19

ACE inhibitor and beta blocker

Question 20

What drug class is used first line in all symptomatic stages of heart failure?

Answer 20

Loop diuretics

Question 21

What drug is used to control ventricular rate in patients with AF, or for symptom relief of severe symptoms in advanced heart failure?

Answer 21

Digoxin

Question 22

Which type of heart failure are implantable devices reserved for? Give two examples of these?

Answer 22

HFREF / cardiac resynchronisation therapy or implantable defibrillator

Question 23

What surgical management can be used for patients with heart failure due to primary valvular disease?

Answer 23

Valve replacement

Question 24

What surgical management can be used for patients with heart failure due to multi-vessel coronary artery disease?

Answer 24

CABG

Question 25

Both types of heart failure reduce the cardiac output. This leads to the upregulation of what two systems in order to compensate?

Answer 25

Sympathetic nervous system and RAAS

Question 26

Right sided heart failure results in failure to clear blood returning from the systemic circulation. This leads to a rise in systemic venous pressure, which can cause what symptoms and signs?

Answer 26

Peripheral oedema, elevated JVP, hepatomegaly

Question 27

Left sided heart failure results in increased pressure in the left atrium and pulmonary circulation, which can cause what symptoms and signs?

Answer 27

Dyspnoea (including orthopnoea and PND) and pulmonary oedema

Question 28

What are some causes of left sided heart failure?

Answer 28

Ischaemic heart disease, valvular disease, cardiomyopathies

Question 29

What are some causes of right sided heart failure?

Answer 29

Secondary to left sided, cor pulmonale, congenital heart disease

Question 30

How is ejection fraction calculated?

Answer 30

(Stroke volume / end diastolic volume) x 100

Question 31

What is the ejection fraction in healthy adults?

Answer 31

> 50%

Question 32

Calculating the ejection fraction is used to divide heart failure into two main subtypes- what are these?

Answer 32

Heart failure with reduced ejection fraction (systolic) and heart failure with preserved ejection fraction (diastolic)

Question 33

What is the most common cause of chronic heart failure?

Answer 33

Ischaemic heart disease

Question 34

To try to prevent chronic heart failure, cardiovascular risk management should be optimised in order to avoid what two things?

Answer 34

Ischaemic heart disease (which causes HFREF) and left ventricular hypertrophy (which causes HFPEF)