Heart Failure

Question 1

Heart failure definition

Answer 1

Cardiac output inadequate for body requirements

Question 2

Systolic heart failure definition

Answer 2

Inability of ventricles to contract properly

Question 3

Systolic heart failure ejection fraction

Answer 3

< 40%

Question 4

Causes of systolic heart failure

Answer 4

IHD

MI

Cardiomyopathy

Question 5

Diastolic heart failure definition

Answer 5

Inability of the ventricle to relax and fill properly

Increased filling pressures

Question 6

Diastolic heart failure ejection fraction

Answer 6

> 50%

Question 7

Causes of diastolic heart failure

Answer 7

Constrictive pericarditis

Tamponade

Restrictive cardiomyopathy

HTN

Question 8

Types of heart failure

Answer 8

Systolic heart failure

Diastolic heart failure

Usually co-exist

Question 9

Categories of heart failure

Answer 9

Left sided

Right sided

Congestive Cardiac Failure (L+R)

Question 10

Acute heart failure / Acute decompensation of chronic heart failure Sx

Answer 10

Pulmonary / peripheral oedema

+/- peripheral hypoperfusion

Question 11

Chronic heart failure

Answer 11

Develops slowly

Arterial pressure well mantained until late

Question 12

Low output heart failure definition

Answer 12

Low CO

Fails to increase on exertion

Question 13

Causes of low output heart failure

Answer 13

Pump failre

Excessive preload

Chronic excessive afterload

Question 14

Causes of excessive preload

Answer 14

MR

Fluid overload

Question 15

Causes of chronic excessive afterload

Answer 15

AS

HTN

Question 16

High output heart failure definition

Answer 16

Rare

Normal CO

Body requirements still not met (eg. greater demand)

Question 17

Causes of high output heart failure

Answer 17

Anaemia

Pregnancy

Hyperthyroidism

Paget’s disease

Beri beri

Question 18

Presentation of high output heart failure

Answer 18

Initially RVF

Later LVF

Question 19

Diagnosis of heart failure

Answer 19

Framingham criteria:

• 2 major OR
• 1 major + 2 minor

Question 20

Major Framingham criteria

Answer 20

PND

Crepitations

Cardiomegaly

Raised JVP

Acute pulmonary oedema

Question 21

Minor Framingham criteria

Answer 21

Bilateral ankle oedema

SOB on normal exertion

Tachycardia > 120

Nocturnal cough

Hepatomegaly

Pleural effusion

Question 22

Ix for heart failure

Answer 22

ECG + BNP

Echo if either are abnormal

Question 23

Mx of chronic heart failure

Answer 23

Conservative

Medical

Question 24

Conservative Mx of chronic heart failure

Answer 24

Stop smoking

Reduce salt intake

Weight loss

Question 25

Medical Mx of chronic heart failure

Answer 25

Diuretics / Spironolactone

ACEi / Vasodilators

Beta blocker

Digoxin

Question 26

New York classification of heart failure

Answer 26

I: No SOB on normal activity

II: SOB on normal activity

III: SOB on minor activity

IV: SOB at rest

Question 27

BNP

Answer 27

B-type Natriuretic Peptide

Question 28

BNP level to diagnose heart failure

Answer 28

> 100 ng/L

Question 29

BNP level to rule out heart failre

Answer 29

< 50 ng/L

Question 30

Causes of RVF

Answer 30

• LVF
• Cor pulmonale
• Tricuspid and pulmonary valve disease

Question 31

Cor pulmonale definition

Answer 31

RVF due to lung disease / pulmonary HTN

Question 32

Right ventricular failure signs

Answer 32

↑JVP
Hepatomegaly
Oedema
Ascites

Nausea

Question 33

Left ventricular failure causes

Answer 33

IHD
Idiopathic dilated cardiomyopathy
Systemic HTN
Mitral and aortic valve disease

Question 34

Left ventricular failure Symptoms

Answer 34

SOB

Orthopnoea + PND

Nocturnal cough (± pink, frothy sputum)

Cardiomegaly

Bibasal creps

(Pulmonary oedema)

Question 35

Acute mx of heart failure / pulmonary oedema

Answer 35

Position pt sitting up

O2

Nitrates

Morphine + anti-emetic

Loop diuretic