Left Ventricular Failure

Question 1

How common is LVF

Answer 1

• Most common type of heart failure

Question 2

Who does it affect

Answer 2

• M>F

- Elderly

Question 3

What causes it

Answer 3

2 types - usually co-exist

• Systolic failure
• Diastolic failure
• Acute MI/ Ischaemia
• HTN
• Leaking heart valves
• Acute mitral regurg (papillary muscles/chordae rupture)
• Arrhythmias
• Aortic dissection
• Cardiac tamponade
• Endo/myocarditis
• Hypothyroidism
• Heart defect

Question 4

What are the 2 types of failure + what causes

Answer 4

Systolic failure
- Inability of ventricle to contract normally (IHD, MI, cardiomyopathy)

Diastolic failure
- Loses ability to fully relax = increased filling pressures (constrictive pericarditis, tamponade, HTN, restrictive cardiomyopathy)

Question 5

What are the risk factors

Answer 5

• Age
• Congenital heart defect (e.g. abnormal heart valve, BV connections + viral infections)
• Diabetes
• Smoking
• HTN
• Physical inactivity
• Obesity
• Heart defects

Question 6

How does it present

Answer 6

• Dyspnoea
• Poor exercise tolerance
• Fatigue
• Orthopnoea
• PND-sleeping with pillows
• Nocturnal cough- pink frothy sputum, wheeze (cardia asthma)
• Nocturia
• Cold peripheries
• Weight loss
• Muscle wasting

Question 7

What are the signs on examination

Answer 7

• Bi-basal crackles +/- wheeze (cardiac asthma)
• Pulm oedema (due to back pressure)
• Central cyanosis- late sign of severe pulm oedema
• Pleural effusion
• Laterally displaced apex beat- enlarged heart

Question 8

What are the differential diagnoses

Answer 8

Pneumonia - sputum, consolidation on CXR

Question 9

What investigations would you perform

Answer 9

ECG- ischaemia, HTN or arrhythmias

Chest X-ray-

• Alveolar oedema (Bats wings)
• Interstitial oedema (Kerley B lines)
• Cardiomegaly
• Upper lobe diversion
• Pleural effusion

Echocardiography
- systolic/diastolic function, valvular heart disease, cardiomyopathies

Question 10

What is the treatment for LVF

Answer 10

Diuretics- loop (furosemide, bendroflumethiazide), potassium sparing diuretics if predisposed to arrhythmias or K+ losing conditions

ACEi- (reduce preload) Consider in all with LV systolic dysfunction, consider ARBs if cough is a problem

Beta-Blockers

Spironolactone- use in those still symptomatic despite optimal therapy

Digoxin

Vasodilators and nitrates- in patients who are intolerant of ACEi and ARBS