Heart Failure (CCF)

Question 1

What are the six most important causes of heart failure in South Africa and specify whether each cause is more likely to occur in young adults, middle aged or elderly?

Answer 1

• IHD (Middle and Elderly)
• Dilated Cardiomyopathy (DCM) (Middle and elderly)
• Hypertension (Middle and elderly)
• Valvular heart disease (Young)
• Alcohol and Drugs (Young and Middle aged)
• Arrythmias (Elderly)

Question 2

Explain the difference in pathophysiology between systolic and diastolic left ventricular dysfunction.

Answer 2

Systolic ventricular dysfunction: Decreased Contractility Decreased CO

Diastolic ventricular dysfunction: decreased filling so increased atrial pressure

Question 3

How do you grade dyspnoea according to the New York Heart Association grading?

Answer 3

I - no symptoms, no limitations
II - mild symptoms + slight limitations
III - marked limitations due to symptoms
IV - severe limitations at rest

Question 4

Why do patients with heart failure develop pitting pedal oedema?

Answer 4

Venous blood backs up, increasing hydrostatic pressure

Question 5

What causes non-pitting oedema?

Answer 5

Lymphoedema, lipoedema, myxoedema

Question 6

What other conditions can result in oedema (differential diagnosis of oedema and ascites)?

Answer 6

Renal failure, pregnancy,

liver failure, DVT, burns, inflammation, filariasis

Question 7

What is peripheral cyanosis and what does it tell you about left ventricular function?

Answer 7

Blue discolouration of

peripheries. CO insufficient.

Question 8

What is atrial fibrillation and what is the characteristic of the pulse in atrial fibrillation?

Answer 8

Irregularly irregular

tachycardia caused by atrial ectopic beats.

Question 9

What sign is present in intravascular fluid overload?

Answer 9

An elevated JVP

Question 10

Large cv waves

Answer 10

Tricuspid regurgitation & Pulmonary HPT

Question 11

Rapid x and y descents

Answer 11

Cardiac tamponade &

Constrictive pericarditis

Question 12

Cannon a wave

Answer 12

Tricuspid stenosis, Pulmonary hypertension

Question 13

Explain the pathophysiology of a pressure overloaded and a volume overloaded apex beat.

Answer 13

Pressure - LV hypertrophy

Volume - DCM or valve regurg

Question 14

Explain the mechanisms of S3 and S4 added sounds.

Answer 14

S3 - Rapid ventricular filling

S4 - Pathological. Occurs in late diastole as atria contract, before S1. (Stiff ventricle)

Question 15

What are the symptoms and signs of pulmonary oedema (including those when lying down at night)?

Answer 15

Orthopnea,
Paroxysmal nocturnal dyspnoea, SOB, Frothy sputum, crackles
Feeling of suffocating/drowning, Wheeze, Anxiety, Cough, Fatigue,

Question 16

What is cor pulmonale? What causes it and what are the signs on general and CVS examination?

Answer 16

Hepatomegally, oedema, angina, heaves, JVP

Question 17

Aortic Stenosis

Answer 17

Anacrotic pulse

Mid-systolic murmur

Question 18

Aortic regurgitation

Answer 18

Collapsing pulse

Mid diastolic murmur (Austin Flint)

Question 19

Mitral stenosis

Answer 19

Mid diastolic murmur

Loud S1

Question 20

Mitral regurgitation

Answer 20

Soft S1

Pansystolic murmur

Question 21

Tricuspid regurgiation

Answer 21

Pansystolic murmur