Systolic Heart Failure

Question 1

Which anatomical structures are involved in systolic heart failure?

Answer 1

Usually the left ventricle

The right ventricle may also be involved, together or separately

Question 2

If a patient does not have systolic heart failure, what is the role of the ventricles?

Answer 2

To ensure a normal supply of blood to the lungs and body at the appropriate pressure to allow adequate blood flow

Question 3

What structural abnormality of the ventricles is usually present and why?

Answer 3

The ventricles are often dilated

This is a result of the heart attempting to pump more blood

Question 4

What structural abnormality of the valves is usually present and why?

Answer 4

Valve regurgitation

This results from ventricular dilation due to stretching of the valve ring

Question 5

What is valve regurgitation?

Answer 5

Blood leaks backwards into the atria

Question 6

What happens to the heart’s ability to pump blood in systolic heart failure?

Answer 6

It loses its ability to pump enough blood to meet the body’s metabolic needs

First in response to vigorous exercise, then to moderate exercise and then at rest

Question 7

What is the most common prior event to systolic heart failure?

Answer 7

Myocardial infarction

Question 8

What is viral myocarditis and how can it lead to systolic heart failure?

Answer 8

It starts as a respiratory infection, the heart muscle is infected by a virus

The antibodies fighting the virus will also damage the heart muscle

Question 9

What usually causes systolic heart failure in younger people?

Answer 9

viral myocarditis

Question 10

What type of drug may cause systolic heart failure?

Answer 10

Chemotherapy drugs

These will poison the heart muscle as an unwanted side effect

Question 11

What symptoms are usually experienced by the patient?

Answer 11

1. fatigue
2. dyspnoea
3. orthopnoea
4. paroxysmal nocturnal dyspnoea
5. nocturia
6. oedema - ankle swelling

Question 12

What is orthopnoea?

Answer 12

Breathlessness when lying flat

Question 13

What is paroxysmal nocturnal dyspnoea?

Answer 13

sudden breathlessness in the night

Question 14

What is nocturia?

Answer 14

passing excess urine at night

Question 15

What clinical signs involving the heart may be detected?

Answer 15

High jugular venous pressure (JVP)

Tachycardia

Question 16

What other clinical signs may be observed?

Answer 16

1. tachypnoea
2. ankle swelling (oedema)
3. hypotension
4. cachexia
5. anorexia

Question 17

What are cachexia and anorexia?

Answer 17

Cachexia - loss of skeletal muscle mass

Anorexia - loss of appetite

Question 18

What 3 clinical tests are used to investigate the condition?

Answer 18

1. echocardiogram
2. blood test for BNP
3. ECG

Question 19

What abnormalities may be detected in the echocardiogram?

Answer 19

It will show dilated heart chambers which contract weakly

It may show leaking valves

Question 20

What abnormalities would be detected in a blood test?

Answer 20

Levels of brain natiuretic peptide will be raised

Question 21

Why may an ECG be abnormal?

Answer 21

It is usually abnormal due to underlying disease

Question 22

What are patients advised to do at home and why?

Answer 22

Weight themselves daily to detect changes in fluid retention

Question 23

Which 4 drugs are involved in standard drug treatment for systolic heart failure?

Answer 23

1. loop diuretic - furosemide
2. potassium-retaining diuretic - spironolactone
3. ACE inhibitor - ramipril
4. beta-blocker

Question 24

What type of pacemaker may be given to a patient with systolic heart failure?

Answer 24

It resynchronises the right and left ventricle systolic contraction

Question 25

How is systolic heart failure described?

Answer 25

It is not truly a disease - it is the consequence of many possible diseases

Question 26

What is the long term treatment for systolic heart failure?

Answer 26

Diagnosing and treating any underlying disease

e.g. narrowing of coronary arteries