HF Workshop

Question 1

S3 heart sound

Answer 1

Signifies you have a non compliant, weakly contracting ventricle
Early diastole
Usually from volume overload

Question 2

S4 heart sound

Answer 2

From having a stiff ventricle
Late diastole
Usually from pressure overload

Question 3

Signs and symptoms of HF

Answer 3

Breathlessness
Orthopnea
PND
Reduced exercise tolerance
Fatigue
Ankle swelling
Elevated JVP
Hepatojugular reflex
S3 present
Laterally displaced apical impulse
Cardiac murmur

Question 4

What happens to Na in HF?

Answer 4

You become hyponatremic
Kidneys sense a low perfusion, so activate RAAS and aldosterone to retain Na
At the extreme, if you cannot maintain fluid status with just Na, your ADH turns on
You end up taking in more water than Na (even though you have lots of Na) so you end up hyponatremic
But really its a pathologially high Na state and water state

Question 5

Triple therapy for HF

Answer 5

ACEI
Beta blocker
MRA (for blocking neurohormonal path/RAAS)

Question 6

PCWP

Answer 6

Pulmonary capillary edge pressure
Insert catheter into venous circ and travel to pulmonary capillaries
Pressure here can be approximated to be the LA pressure

Question 7

Why do ACEI cause cough?

Answer 7

From increased bradykinin