Heart failure

Question 1

how is left ventricular ejection fraction (LVEF) measured

Answer 1

echo

Question 2

how much does LVEF need to be reduced to be termed HF with reduced ejection fraction (HF-rEF)

Answer 2

35-40%

Question 3

how does HF-rEF and HF-pEF related to systole and diastole

Answer 3

HF-rEF is usually problem with systole + contraction // HF-pEF is usually problem with diastole + filling

Question 4

what can cause systolic dysfunction

Answer 4

IHD // dilated cardioyopathy // myocarditis // arrythmia

Question 5

what can cause diastolic dysfunction

Answer 5

HCOM // restrictive cardiomyopathy // tamponade // contrictive pericarditis

Question 6

what side of the heart does HF-rEF and HF-pEF cause failure of

Answer 6

left

Question 6

what side of the heart does HF-rEF and HF-pEF cause failure of

Answer 6

left

Question 7

what can cause right sided HF

Answer 7

increased RV afterload (pulm hypertension) // increased right ventricular preload (tricuspid regurg)

Question 8

symptoms LV HF

Answer 8

pulmonary oedea - dyspnoea, orthopnoea, nocturnal dypnosea, basal fine crackles

Question 9

symptoms RV HF

Answer 9

periphal oedema // raised JVP // hepatomegaly // weight gain (fluid retention) // anorexia?

Question 10

what is high output cardiac failure

Answer 10

heart working normally but cannot meet bodies metabolic needs

Question 11

causes high output HF

Answer 11

anaemia // AV malformation // Pagets // pregnancy // wet beri-beri (thiamine def)

Question 12

symptoms chronic HF

Answer 12

dyspnoea // cough, worse at night // pink sputum // wheeze // weight loss // RSHF: raised JVP. ankle oedema

Question 13

first line invx HF

Answer 13

proBNP blood tests

Question 14

if high levels of BNP what test is done next in HF

Answer 14

high –> echo 2 weeks // raised –> echo 6 weeks

Question 15

1st line mx chronic HF

Answer 15

ACEi + BB

Question 16

2nd line mx HF

Answer 16

aldosterone antagonist eg spironolactone

Question 17

what needs to be monitored if on ACEi + aldosterone antagonist

Answer 17

hyperkalaemia

Question 18

what drug may be used 2nd line in HF with reduced ejection fracture (<45%)

Answer 18

SGLT2i eg dapagliflozin

Question 19

when would ivabradine be indicated in chronic HF

Answer 19

3rd line if rhythm >75 and LV fraction <35%

Question 20

when would sacubitril-valsartan be indicated in chronic HF

Answer 20

3rd line if LV fraction <35% (ACEi + BB washout prior)

Question 21

when would digoxin be indicated in chronic HF

Answer 21

3rd line, maybe if patient has AF

Question 22

when would hydralazine be indicated in chronic HF + what is it given with

Answer 22

3rd line in afro-carribean + nitrates

Question 23

when would cardiac resynchronisation be indicated in chronic HF

Answer 23

wide QRS eg LBBB

Question 24

3rd line mx chronic HF

Answer 24

ivabradine, sacubriril-valsartan, digoxin, hydralazine + nitrates, cardiac resynchronisation

Question 25

what vaccines do patients on HF need

Answer 25

annual influenza + one of pneumococcal

Question 26

what drug can be given for fluid overload in HF and what effect does this have on prognosis

Answer 26

loop diuretics - no effect on mortality

Question 27

what classification defines severity of HF and what are the classes

Answer 27

NYHA: 1-->4, no symptoms --> slight limited activity --> moderate limited --> severe

Question 28

what can cause de-novo acute HF

Answer 28

ischamia // viral myopathy // toxin // valve dysfunction

Question 29

what can cause acute HF

Answer 29

ACS // hypertension // arrhthmia // valves

Question 30

presentation acute HF

Answer 30

SOB // cyanosis // raised JVP // oedema // reduced exercise // JVP // crackles + wheeze // S3 heart sound

Question 31

invx acute HF

Answer 31

FBC // CXR // ECHO // BNP

Question 32

what treatment should all patients with acute HF get

Answer 32

IV loop diuretic

Question 33

when are nitrates given in acute HF (3)

Answer 33

if there is ischaemia, hypertension, valve disease

Question 34

what ventilation do patients with acute HF + resp failure receive

Answer 34

CPAP

Question 35

what mx can be given in acute HF + low BP (cardiogenic shock) (3)

Answer 35

inotropic agents eg dobutamine // vasopressors eg norepinephrine // devices