HF

Question 1

Define hf

Answer 1

Cardiac failure describes when cardiac output cannot meet metabolic demands.

Question 2

What is congestive hf

Answer 2

combination of right and left sided ventricular failure

Question 3

RF for hf

Answer 3

• revious myocardial infarction:the single greatest risk factor
• Non-modifiable risk factors: male gender, increasing age
• Cardiovascular risk factors: ischaemic heart disease, hypertension, hypercholesterolaemia, diabetes
• Valvular heart disease
• Renal failure: causes ‘high-output’ heart failure due to fluid overload
• Atrial fibrillation

Question 4

What occurs in systolic hf

Answer 4

• The ejection fraction is not preserved: an ejection fraction of 40% or less would indicate systolic heart failure.
• The low stroke volume is due to the ventricles not pumping enough blood out.

Question 5

What can cause a decrease in contractility for systolic hf

Answer 5

Mi infarction ant/lateral
dilated cardiomyopathy
IHD- less blood and o2 to the heart myocytes die
HTN-

Question 6

What occurs in diastolic heart failure

Answer 6

In this case, the stroke volume is low but the ejection fraction is preserved. The reason for the low stroke volume is due to reduced filling of the ventricle (reduced preload)

Question 7

What causes dystolic hf

Answer 7

• left ventricular hypertrophy
• restrictive caardiomyopathy
• valvular disease
• AF

Question 8

How does left sided failure cause right sided failure

Answer 8

Blood starts backing up into the lungs causing pulmonary oedema and congestion. The pulmonary hypertension puts pressure on the right ventricle (cor pulmonale) and causes right-sided heart failure.

Question 9

Frank starling law

Answer 9

In a normalheart, increased ventricular filling results in increased contraction via theFrank-Starling law→ increased cardiac output

Question 10

What compensatory mechanisms occur in hf

Answer 10

• increase in hr
• RAAS activation

Question 11

Symptoms of left sided hf

Answer 11

• Dyspnoea: particularly exertional
• Orthopnoea (SOB when lying flat) and paroxysmal nocturnal dyspnoea (SOB at night)
• Fatigue and weakness
• Cough with pink, frothy sputum
• Cardiogenic wheeze

Question 12

signs of left sided hf

Answer 12

• Tachypnoea and tachycardia
• Cool peripheries
• Peripheral or central cyanosis
• Displaced apex beat
• Stony dull percussion: if an effusion is present
• Crackles on auscultation: coarse bi-basal crackles due to pulmonary congestion
• Third heart sound (S3)

Question 13

right sided hf signs

Answer 13

• Due to backing up of fluid:
  
  • Raised JVP
  • Peripheral pitting oedema
  • Hepatosplenomegaly
  • Ascites

Question 14

symptoms of right sided hf

Answer 14

• Fatigue and weakness
• Due to backing up of fluid
  
  • Swelling in the legs
  • Distended abdomen

Question 15

severity criteria for hf

Answer 15

class 1 - no limits on activity , ordinary stuff does not cause SOB, palpitations

class 2- slight limits on activity , comfy at rest , but physical activity results in sob and fatigue

class 3- marked limit on activity , comfy at rest but mild activity causes problems

class 4- cant do any activity without discomfort , cardiac insufficiency at rest

Question 16

Primary investigations for HF

Answer 16

• NT-proBNP: increased in chronic heart failure
• ECG:broad QRS complexes; evidence of left ventricular hypertrophy
• CXR:

Question 17

What would CXR show for hf

Answer 17

• A-Alveolar oedema (batwing opacities)
• B- KerleyBlines
• C-Cardiomegaly
• D-Dilated upper lobe vessels
• E- Pleural effusion

Question 18

Other investigations to consider

Answer 18

• FBC:anaemia may be a cause of ‘high-output’ heart failure
• U&Es: to investigate for renal failure as an underlying cause of heart failure; also U&Es monitored as ACEi’s and aldosterone antagonists can cause electrolyte abnormalities
• Blood lipids and fasting blood glucose:screen for hypercholesterolaemia and evidence of diabetes

Question 19

1st line mx for hf

Answer 19

BB - bisoprolol + acei ramipril

Question 20

2nd line mx for hf

Answer 20

aldosterone antagonist - spironolactone

Question 21

3rd ;ine mx for hf

Answer 21

• crt
• icd
• digoxin

Question 22

if acei is not tolerated what are the options

Answer 22

angiotensin receptor blocker candersartan or losarsartan

Question 23

why would you give a spironolactone

Answer 23

when ejection fraction is low

Question 24

complications of hf

Answer 24

• pleural effusion
• arrhythmias
• acute renal failure

Question 25

define high cardiac output hf

Answer 25

In high output cardiac failure cardiac output is normal, but there is an increase in peripheral metabolic demands which exceed those that can be met with maximal cardiac output.

Question 26

causes of high CO HF

Answer 26

Anaemia
Arteriovenous malformation
Paget’s disease
Pregnancy
Thyrotoxicosis
Thiamine deficiency (wet Beri-Beri)

Question 27

AAPPTT

Answer 27

Anaemia
Arteriovenous malformation
Paget’s disease
Pregnancy
Thyrotoxicosis
Thiamine deficiency (wet Beri-Beri)

Question 28

WHEN IS BNP released

Answer 28

in response to cardaic stretch

Question 29

interpreting bnp levels

Answer 29

if levels are ‘high’ arrange specialist assessment (including transthoracic echocardiography) within 2 weeks
if levels are ‘raised’ arrange specialist assessment (including transthoracic echocardiography) echocardiogram within 6 weeks

Question 30

3 cardinal non specific signs

Answer 30

SOB
ankle swelling
fatigue

Question 31

result on left sided hf

Answer 31

pulomary backlog, pulmonary oedema

Question 32

results of right sided hf

Answer 32

systemic venous backlog - peripheral oedemaa