Left Heart Failure

Question 1

what is it

Answer 1

low cardiac output from left side of heart

can be acute or chronic

Question 2

what are symptoms

Answer 2

pulmonary oedema, orthopnoea, paroxysmal nocturnal dyspnoea

Question 3

what are the signs

Answer 3

tachycardia
fine crepitations
pleural effusion (more common in chronic than acute)
third heart sound
cardiomegaly and bat wing shadows in lower zones on CXR
kerley B lines (oedema)

Question 4

what are the causes

Answer 4

ischaemic heart disease
cardiomyopathy
valvular disease

Question 5

how is it diagnosed

Answer 5

NP test - produced by LV in response to strain

transthoracic echo to confirm and identify cause

Question 6

what is the 1st line treatment

Answer 6

ACEI (lisinopril)
B blocker (start low go slow)
Thiazide diuretic (bendroflumethiazide)

Question 7

what is 2nd line treatment

Answer 7

ARB (losatran)
K sparing diuretic (spironolactone) 
hydralazine (vasodilator) in combo with nitrate
Digoxin in later stages 
Loop diuretic (furosemide) in severe HF

Question 8

treatment of ACUTE

Answer 8

sit up, oxygen, IV furosemide, IV morphine (not in COPD)