Heart Faluire

Question 1

Signs of HF?

Answer 1

• overrated jugular venous pressure
• SOB
• awaken from sleep due to SOB
• SOB when laying down
• tachycardia
• odema

Question 2

What percentage is preserved ejection fractions

Answer 2

> 50%

Question 3

What percentage is reduced ejection fraction?

Answer 3

<40%

Question 4

Non pharmacological management?

Answer 4

Decrease sodium and fluid intake
Increase activity

Question 5

What is 1st line treatment

Answer 5

ACEI (or ARB) + BB

AND MRA - if symptoms worsen
•spironolactone(diuretic)

Question 6

What is second line, if ejection fraction is <35%

Answer 6

Replace ACEI with sacubitril Valsartan

Question 7

What is second line if HR is >75 and ejection fraction is under 35%

Answer 7

Add ivadradine

Question 8

What is second line for Africans

Answer 8

Add nitrates + hydralazine

Question 9

What is second line if symptoms are worsening

Answer 9

Digoxin

Question 10

What pathiophisological changes occur in HF

Answer 10

• myocardial hyperthrophy
• increase cardiac output/performance
• activation of neurohumoral changes

Question 11

What nurohumoral changes occur?

Answer 11

Activation of sympathetic NV
• increase HR
• increase BP

Activation of RAAS - conversion of ATI to AT2 =
• vasoconstriction
• promoting release of Aldesterone (water retention

Increase Aldesterone release - retention of Na and fluid
• increase blood volume
• increase BP

Release of endothelin
• vasoconstriction

Question 12

What investigations would you do in HF

Answer 12

• echo
• ECG
• troponin
• chest x ray
• chest assessment