Heart Failure

Question 1

Define HF

Answer 1

Cardiac output is inadequate for body’s requirements

Question 2

Define systolic failure

Answer 2

Inability of ventricle to contract normally, resulting in decreased cardiac output

Question 3

Define diastolic failure

Answer 3

Inability of ventricle to relax and fill normally, causing increased filling pressures

Question 4

What is HFpEF?

Answer 4

Heart failure with preserved EF

Question 5

What is CCF a combination of?

Answer 5

LVF and RVF

Question 6

Define acute HF

Answer 6

New-onset acute or decompensation of chronic HF characterised by pulmonary and/or peripheral oedema with or without signs of peripheral hypoperfusion

Question 7

Define chronic HF

Answer 7

Develops or progresses slowly

Question 8

What are some causes of SF?

Answer 8

IHD, MI, Cardiomyopathy

Question 9

What are some causes of DF?

Answer 9

Aortic stenosis, chronic HTN

Question 10

What are some causes of RHF?

Answer 10

Right ventricular infarct, PH, PE, COPD, LHF, Cor pulmonale

Question 11

How does LVF present?

Answer 11

Dyspnoea, fatigue, orthopnoea, poor exercise tolerance, nocturnal cough, wheeze, nocturia, cold peripheries

Question 12

How does RVF present?

Answer 12

Peripheral oedema, ascites, nausea, facial engorgement, epistaxis

Question 13

What is epistaxis?

Answer 13

Nose bleed

Question 14

What are signs of general HF?

Answer 14

Elevated JVP, 3rd or 4th heart sounds, displaced apex beat, murmurs, bibasal crackles

Question 15

What criteria do you use for CCF?

Answer 15

Framingham criteria

Question 16

What two tests would you do first?

Answer 16

ECG and B-type natriuretic peptide

Question 17

Where is BNP secreted from?

Answer 17

Ventricular myocardium

Question 18

What causes an increase in plasma BNP?

Answer 18

MI, LV dysfunction, tachycardia

Question 19

How do ANP and BNP work?

Answer 19

They help stretched atria and ventricles by increasing GFR, decreasing Na+ reabsorption, relaxing smooth muscle

Question 20

What is the overall effect of ANP and BNP?

Answer 20

Reduced fluid load and preload

Question 21

When would you do an echo?

Answer 21

If ECG or BNP are abnormal

Question 22

What signs can you see on a CXR in LVF?

Answer 22

ABCDE. Alveolar oedema (Bat’s wings), kerley B lines, Cardiomegaly, Dilated prominent upper lobe vessels, pleural Effusion

Question 23

What lifestyle changes would you make in chronic HF?

Answer 23

Stop smoking and alcohol, eat less salt, optimise weight and nutrition

Question 24

What drug options do you have?

Answer 24

Diuretics, ACE-i, Beta-blockers, mineralocorticoid receptor antagonists, digoxin

Question 25

When would you consider ACE-i?

Answer 25

In all LVSD

Question 26

When would you give ARB?

Answer 26

If cough from ACE-i is a problem

Question 27

When would you add Digoxin?

Answer 27

In patients with LVSD

Question 28

What classification system is used for HF?

Answer 28

New York Classification of HF

Question 29

What is stage I?

Answer 29

Heart disease present with no undue dyspnoea from ordinary activity

Question 30

What is stage II?

Answer 30

Comfortable at rest, dyspnoea during ordinary activity

Question 31

What is stage III?

Answer 31

Less than ordinary activity causes dyspnoea, limiting

Question 32

What is stage IV?

Answer 32

Dyspnoea present at rest, all activity causes discomfort

Question 33

What can cause LHF?

Answer 33

Coronary artery disease, MI, Cardiomyopathy, Congenital heart defects, valvular heart disease, arrhythmias

Question 34

How do diuretics help?

Answer 34

They reduce preload and pressures on ventricles

Question 35

Give an example of an ACE-i

Answer 35

Ramipril

Question 36

Give an example of a beta-blocker

Answer 36

Bisoprolol

Question 37

Give an example of a mineralocorticoid receptor antagonist

Answer 37

Spironolactone

Question 38

Which diuretic/mineralocorticoid receptor antagonist is potassium sparing?

Answer 38

Spironolactone

Question 39

Give some examples of diuretics

Answer 39

Furosemide, bendroflumethazide, spironolactone

Question 40

What is the action of amlodipine?

Answer 40

Inhibition of L-type voltage gated calcium channel in the nephron

Question 41

What is the action of spironolactone?

Answer 41

Inhibition of aldosterone receptor in the distal tubules

Question 42

What is the action of thiazide-like diuretics?

Answer 42

Inhibition of the sodium chloride transporter in the distal convoluted tubule

Question 43

What is the action of furosemide?

Answer 43

Inhibition of the sodium/potassium/chloride symporter in the ascending limb of the loop of Henle

Question 44

What are the three cardinal signs of HF?

Answer 44

Shortness of breath, fatigue, ankle swelling