Left Ventricular Failure

Question 1

What is it?

Answer 1

When cardiac output becomes inadequate for the body’s requirements

Question 2

What are the 2 classes of cause?

Answer 2

Systolic and Diastolic

Question 3

What happens in systolic?

Answer 3

Inability of the ventricle to contract normally causing a reduced ejection fraction <40%

Question 4

What is the cause of systolic? (3)

Answer 4

Ischaemic Heart Disease, Myocardial Infarction, Cardiomyopathy

Question 5

What happens in diastolic?

Answer 5

Inability of the ventricles to relax and fill causing increased filling pressures, ejection fraction is >50%

Question 6

What is the cause of diastolic failure? (4)

Answer 6

Constrictive pericarditis, Tamponade, Restrictive Cardiomyopathy, Hypertension

Question 7

Which is most common?

Answer 7

Systolic and Diastolic usually co-exist

Question 8

What happens when it mixes with right ventricular failure?

Answer 8

You get congestive heart failure

Question 9

Is it common?

Answer 9

Yes, prevalence is 40%

Question 10

Who does it affect?

Answer 10

People over 70, generally males

Question 11

Symptoms (11)

Answer 11

Dyspnoea, Poor exercise tolerance, fatigue, orthopnoea, paroxysmal nocturnal dyspnoea, nocturnal cough, pink sputum, nocturia, wheeze, weight loss, muscle wasting

Question 12

Signs (4)

Answer 12

Cyanosis, hypotension, displaced apex beat, murmurs

Question 13

What bloods would you do?

Answer 13

FBC, BNP, U&E

Question 14

Other investigations:

Answer 14

ECG, Chest X-ray, ECHO

Question 15

What is low output failure?

Answer 15

Cardiac output is low and fails to increase on exertion

Question 16

What causes low output? (2)

Answer 16

Pump failures e.g B-blockers, heart block, previous MI

Or Excessive preload e.g Mitral regurgitation, fluid overload

Question 17

What is high output failure?

Answer 17

Cardiac output fails to meet the needs of the body

Question 18

What causes high output? (5)

Answer 18

Pregnancy, Anaemia, Hyperthyroid, Paget’s, Arteriovenous Malformation

Question 19

Drug Treatment (5)

Answer 19

Diuretics, ACE inhibitors, B-blocker, Digoxin, Vasodilators

Question 20

Other treatments (5)

Answer 20

Smoking cessation, reduce salt intake, optimise weight and nutrition, treat any causes e.g Anaemia

Question 21

Is there a good prognosis?

Answer 21

Not really, 25-30% die within 5 years of diagnosis, and symptom presentation generally means a decline