Heart failure

Question 1

What is heart failure?

Answer 1

Output of the heart is incapable of meeting the demands of the tissues.

Question 2

What is high output failure?

Answer 2

Demands of the system have increased beyond the capacity of the pump-e.g. anaemia and thrombotoxicosis

Question 3

What is low output failure?

Answer 3

Pump is failing and not strong enough to force liquid around the body e.g. cardiac defect e.g. MI or valve disease

Question 4

What is congestive heart failure?

Answer 4

Heart failure on both sides

Question 5

What is the difference between systolic and diastolic dysfunction?

Answer 5

Systolic dysfunction- enlarged ventricles fill with blood and ventricles pump out less than 40 to 50% of the blood
Diastolic dysfunction- stiff ventricles fill with less blood than normal and the ventricles pump out about 60% of the blood but the amount may be lower than normal.

Question 6

What are the drug causes of low output failure?

Answer 6

Beta blockers, corticosteroids and anti cancer drugs

Question 7

What are the heart muscle disease causes of low output failure?

Answer 7

MI, myocarditis, obesity and diabetes

Question 8

What is the pressure overload causes of low output failure?

Answer 8

Hypertension and aortic stenosis

Question 9

What are the volume overload causes of low output failure?

Answer 9

Mitral and aortic incompetence

Question 10

What are the arrythmia causes of low output failure?

Answer 10

Atrial fibrillation and heart block

Question 11

What are the signs and symptoms of left heart failure?

Answer 11

Lung and systolic effects- dyspnoea, tachycardia, low BP, low volume pulse

Question 12

What are the signs and symptoms of right heart failure?

Answer 12

Venous pressure elevated- swollen ankles, ascites, raised JVP, tender enlarged liver, poor GI absorption

Question 13

What is pitting oedema and what is the sign of increasing severity?

Answer 13

Fluid accumulation in superficial tissues which can be squeezed out by pressure. The higher the pitting is found the worse is the heart failure. e.g. Thigh > calf> ankle

Question 14

What is the acute treatment of heart failure? e.g. when patient is acutely short of breath and gasping and the lungs fill with fluid (oedema)

Answer 14

Emergency hospital management- oxygen, morphine, high dose of frusemide (diuretic)

Question 15

What is the chronic treatment of heart failure?

Answer 15

Community based- improve myocardial function, reduce compensation effects, where possible treat the cause

Question 16

What is the drug therapy in chronic heart failure?

Answer 16

Diuretics- increase salt and water loss, ACE inhibitor- reduce salt/water retention, nitrates- reduce venous filling pressure, inotropes-digoxin, stop negative inotropes e.g. beta blockers and rarely assist pumps and heart transplant.