Left side heart failure

Question 1

What are the two types of left-sided heart failure?

Answer 1

1. Heart failure with reduced ejection fraction (HFrEF) or systolic failure.
2. Heart failure with preserved ejection fraction (HFpEF) or diastolic failure.

Question 2

What is the pathophysiology of LHF?

Answer 2

In systolic heart failure, the inadequate cardiac output leads to elevated left atrial pressures and this gives the majority of the clinical findings.

Question 3

What are the typical presenting symptoms?

Answer 3

· Exertional dyspnoea. 
· Orthopnoea.
· PND.
· Fatigue.
· Wheeze.
· Cough.
· Haemoptysis.

Question 4

What are the typical presenting signs?

Answer 4

· Tachypnoea.
· Tachycardia.
· Peripheral cyanosis.
· Low pulse volume. 
· Cardiomegaly.
· Third heart sound - S3 gallop. 
· Basal crepitations indication pulmonary oedema. 
· Pleural effusions.

Question 5

What investigations would you request?

Answer 5

· FBC.
· U&Es.
· LFTs.
· Cardiac enzymes/troponin.
· TFTs. 
· ECG. 
· CXR. 
· Echo.

Question 6

Why is a FBC requested?

Answer 6

Check for anaemia

Question 7

Why are U&Es requested?

Answer 7

Check for renal dysfunction or electrolyte abnormalities.

Question 8

Why are LFTs requested?

Answer 8

Check for liver congestion.

Question 9

Why are Cardiac enzymes/troponin measured?

Answer 9

Exclude ACS.

Question 10

Why is a CXR requested?

Answer 10

Check for cardiomegaly, alveolar oedema, prominent upper lobe vessels, pleural effusions and Kerley B lines.

Question 11

What heart functions does an ECHO assess?

Answer 11

Ventricular and valvular function.

Question 12

What are the management options for chronic heart failure?

Answer 12

Improve symptoms:
· Loop diuretics (furosemide).
· Digoxin.

Improve prognosis:
· ACE inhibitors/ARB. 
· Beta blockers.
· Spironolactone. 
· Warfarin.

Question 13

What are the management options for acute heart failure?

Answer 13

Resuscitation:
· Sit the patient upright.
· High flow oxygen unless existing hypercapnia.
· Respiratory support using NIV.

Therapies:
· Diamorphine.
· Diuretics.
· IV nitrates.