Heart Failure

Question 1

What is Heart Failure?

Answer 1

A clinical syndrome characterised by several clinical findings and symptoms. The failure of the heart to deliver O2 at a sufficient rate to meet metabolic needs. It can be chronic or acute. Can be right sided or left and it can be systolic or diastolic.

Question 2

How does left sided heart (LVF) failure usually start?

Answer 2

With dysfunction of left ventricle following an MI meaning it is significantly less effective at pumping oxygenated blood into circulation.

Question 3

What can occur as a result of left sided heart failure?

Answer 3

Heart failure can cause blood to build up into pulmonary circulation, fluid build up in lungs resulting in pulmonary oedema, severe dyspnoea, reduced gas exchange

Question 4

What causes right sided heart failure (RVF)?

Answer 4

LVF, COPD, PE, pulmonary stenosis valve disease and left sided heart failure.

Question 5

What can occur as a result of right sided heart failure?

Answer 5

Central venous pressure increases causing fluid build up in peripheral tissues.

Question 6

What are some RVF S&S?

Answer 6

-Pitting oedema in legs, nausea, anorexia, facial engorgement, epistaxis, ascites

Question 7

What are some LVF S&S?

Answer 7

• Dyspnoea
• poor exercise tolerance
• fatigue
• Orthopnoea
• nocturnal cough
• wheeze
• weight loss
• cold peripheries

Question 8

What is chronic heart failure?

Answer 8

Heart failure that develops slowly

Question 9

What is acute heart failure?

Answer 9

Indicates new onset of heart failure or decompensation of chronic heart failure (DHF). Characterised by pulmonary or periphery oedema

Question 10

What is the most common cause of heart failure?

Answer 10

CAD as well as a history of ACS.

Question 11

Discuss chronic and acute heart failure.

Answer 11

Heart failure is a long term condition many people live with. People may develop acute on chronic heart failure if they already have heart failure and present with an exacerbation.
Acute heart failure can either be a decompensation of chronic heart failure or may be the patients first presentation of symptoms.

Question 12

What three forms can acute heart failure present as?

Answer 12

• Acute Pulmonary Oedema (Severe Dyspnoea)
• Peripheral Oedema (With or without PO, peripheral oedema, JVP)
• Cardiogenic Shock

Question 13

Heart Failure A&M

Answer 13

ABCDE

• TC Transfer
• Check for patient care plans, DNACPR etc
• Contact heart failure services if patient is stable and known to them
• History with DD assessment
• Position sitting upright
• Heart failure rarely has normal ECG

Question 14

Discuss Peripheral or Pulmonary Oedema A&M

Answer 14

History and Examination to rule out DD in particular COPD, Asthma,ACS
Establish if patient has care plan
If no increased work of breathing or respiratory distress discuss referral to an appropriate clinician such as at HF nurse or GP

Question 15

Discuss Pulmonary oedema and Respiratory Distress A&M

Answer 15

History and examination to rule out DD in particular COPD, Asthma, ACS
Establish if patient has care plan
IF
RR>25 or SpO2 <90% or increased work of breathing consider 
GTN if BP >110
Consider Furosemide
Consider CPAP
Consider O2

Question 16

Discuss Cardiogenic Shock Hypotension/ Hyperfusion A&M

Answer 16

History and examination to rule out DD in particular COPD, Asthma, ACS
Establish if patient has care plan
BP<90
HR <40 or >130
Commonest cause in new presentation is STEMI
TC Transfer to ED or CCU
Consider O2