Heart Failure & Oedema

Question 1

Heart Failure

Answer 1

Unable to pump in sufficient manner to meet the requirements of tissues

Question 2

Causes of HF

Answer 2

Coronary heart disease/MI
Hypertension
Diabetes
Valve disease- rheumatic
Poorly controlled AF
Idiopathic dilated cardiomyopathy

Question 3

Symptoms of HF

Answer 3

SOB, Orthopnea, Paroxysmal Nocturnal dyspnoea, fatigue, tiredness, ankle swelling, reduced exercise tolerance

Question 4

Clinical signs of HF

Answer 4

Raised JVP, crackles in lower lung fields, 3rd or 4th heart sound, murmur, sacral oedema

Question 5

CXR in HF

Answer 5

Kerley B lines, Perihilar congestion, enlarged heart, pleural effusion

Question 6

ECG

Answer 6

Arrythmias or signs of past MI

Question 7

Echocardiogram

Answer 7

Shows the size of the heart, allows calculation of the ejection fraction

Question 8

BNP levels

Answer 8

ventricular hormone released when damaged so high levels of BNP indicate damage to the ventricle
Highly sensitive

Question 9

Lifestyle modifications

Answer 9

Increase exercise, water salt restriction, vaccination, mental health care

Question 10

Drugs to prolong survival

Answer 10

ACE and ARB inhibitors, 
Beta Blockers
Aldosterone antagonists
Vasodilators
Ivabradine

Question 11

Drugs to improve symptoms

Answer 11

Digoxin, Frusemide

Question 12

New drug that replaces ACE and ARB for heart failure

Answer 12

Entresto - angiotensin receptor neprylisin inhibitor

Question 13

Which vessels remove excess interstitial fluid?

Answer 13

Lymph vessels

Question 14

What two forces are in opposition at either end of the cappiliary?

Answer 14

Hydrostatic and Plasma Osmotic pressure

Question 15

Why does pulmonary oedema lead to SOb

Answer 15

Increases diffusion distance- decreases diffusion rate

reduced lung compliance

Question 16

What does Left ventricular failure cause?

Answer 16

Pulmonary oedema, as backlog of hydrostatic pressure up pulmonary veins into pulmonary capillaries

Question 17

What does right ventricular failure cause?

Answer 17

Systemic oedema, as hydrostatic pressure backlog into systemic veins

Question 18

Two other reasons for raised capillary pressure leading to oedema

Answer 18

Arteriolar dilation

Prolonged standing - ankle oedema

Question 19

How can a reduced plasma osmotic pressure occur?

Answer 19

Malnutrition, protein malabsorption, excessive renal excretion, hepatic failure

Question 20

How can a lymphatic insufficiency occur?

Answer 20

Lymph node damage

Filariasis elephantiasis

Question 21

Difference in the oedema when its due to lymphatic insufficiency?

Answer 21

The oedema is not pitting

Question 22

How can changes in capillary permeability occur?

Answer 22

Inflammation- swelling

Histamine increases leakage of proteins