Week 4

Question 1

Define heart failure.

Answer 1

Heart failure is a condition of impaired cardiac function due to structual or functional disorder that decreases the ability of the ventricles to fill and eject. Therefore the heart cannot pump blood at a volume required to meet the bodies demand.

Question 2

Decribe the pathophysiology of heart failure.

Answer 2

1. myocardial muscle loss
2. changes to surviving myocardial muscle cells
3. muscle hypertrophy
4. ejection function decreases and ventricles dilate in order to maintain stroke volume

Question 3

Name FIVE differing clinical manifestations of both left and right heart failure.

Example: Both left and right experience fatigue, so therefore this is a common clinical manifestation. Left HF experiences dyspnoea, whilst right HF experiences oedema, so these are differing conditions.

Answer 3

Left heart failure

• dyspnoea
• orthopnoea
• dry, hacking cough
• crackles; pulmonary oedema
• nocturia
• tachycardia
• chest pain

Right heart failure

• oedema
• weight gain
• nausea
• anorexia
• GI bloating
• ascites
• tachycardia
• distended jugular veins
• behavioural changes

Question 4

What is pulomonary oedema?

In your own time, look up the pathophysiology.

Answer 4

An abnormal accumulation of fluid in the interstitial tissue and alveoli of the lung.

Question 5

Name the TWO drug families in the 1st line treatment of chronic heart failure, and name at least ONE drug in each family.

Answer 5

ACE inhibitors

• enalopril
• captopril
• ramipril

Angiotensin II receptor blockers

• irbesartan

Question 6

Name the THREE drug families in the 2nd line treatment of chronic heart failure, and name at least ONE drug in each family.

Answer 6

Diuretics

• frusemide (loop diuretic)

Beta-blocker

• bisoprolol
• carvedolol
• metoprolol

Inotropic

• digoxin
• adrenaline
• dobutamine

Question 7

If there is an excess in fluid volume, what are the THREE types of diuretics that could be used?

Answer 7

Thiazides

• hydrocholrothiazide

Loop diuretics

• frusemide

Potassium sparing

• spironolactone

Question 8

Name THREE indications for a CABG.

Answer 8

• unstable angina refractory to medication or percutaneous coronary intervention (PCI)
• left main coronary artery disease
• multi vessel disease
• treatment of MI or heart failure
• complications from PCI
• failed PCI

Question 9

Name FIVE complications associated with CABGs.

Answer 9

• bleeding
• cardiac tamponade
• arrhythmias
• blood pressure alterations
• electrolyte and metabolic disturbances
• atelectasis
• pleural effusion
• pain
• neurological must be monitored