Heart Failure

Question 1

HF

Pathophysiology

Answer 1

Inadequate tissue perfusion inspite of adequate filling pressure

Question 2

HF

Presentation

Answer 2

SOB

Question 3

HF

DDs of SOB

Answer 3

• Heart disease- HF
• Lung disease- Asthma, COPD, Lung fibrosis
• Renal failure- Pleural effusion/ pericardial effusion/ cardiomyopathy/ anemia
• Metabolic acidosis
• Anemia

Question 4

HF

Classifications of HF

Answer 4

• Acute/ Chronic
• Systolic/ Diastolic
• Left/ right

Question 5

HF

Systolic HF

Answer 5

ejection fraction is less (<60%)

Question 6

HF

Diastolic HF

Answer 6

Heart is stiff and unable to stretch

Question 7

HF

In which can the ejection fraction be normal

Answer 7

Diastolic HF

Question 8

HF

Pulmonary edema Sx

Answer 8

• SOB
• B/L coarse crepts
• Patient tries to sit up

Question 9

HF

Immediate Mx of acute heart failure

Answer 9

• Admit the pt
• ABC
• Give O2, if SpO2 <94%
• IV cannula and collect the blood for Ix
• IV frusemide- 80- 120mg
• GTN infusion
• If no response CPPV
• Added measures- Dialysis, venesection

Question 10

HF

IV frusemide function in acute LV failure Mx

Answer 10

Dilatation of veins occurs first,
diuretic effect comes later

Question 11

HF

How long does it take for the diuretic effect of frusemide to come into action

Answer 11

around 30 minutes

Question 12

HF

Function of GTN in acute HF Mx

Answer 12

Venodilation

Question 13

HF

what needs to be done if the high stat frusemide dose cause the BP to crash

Answer 13

the pt may not respond to it so start an infusion (5mg/hr)

Question 14

HF

In which situation should GTN be given in acute LVF

Answer 14

if the BP is normal or high

Question 15

HF

Next step if Frusemide and GTN fails

Answer 15

CPPV

Question 16

HF

In which situation should GTN be avoided

Answer 16

if the BP is low

Question 17

HF

Added measures in acute LVF Mx

Answer 17

• dialysis
• venesection ( not done anymore)

Question 18

HF

LV failure pathophysiology

Answer 18

• LV pumping reduced
• Blood accumulates in the left ventricle
• workload on the L/atrium to send blood to the ventricle is high
• pressure in the L/atrium is high
• pressure increase in the pulm vessels
• fluid leaks out of the pulm vessels giving pulm edema

Question 19

HF

Why CPAP in acute LVF Mx

Answer 19

sending air in a positive pressure will push the fluid out of the airways. Reducing the pulm edema

Question 20

HF

High output HF Examples

Answer 20

• Anemia
• Thyrotoxicosis
• Wet beri beri
• AV fistula
• Paget’s disease

Question 21

HF

High output HF?

Answer 21

cardiac output is high but its still not enough to meet the demands

Question 22

HF

Chronic HF

Answer 22

RHF secondary to LHF

Question 23

HF

Chronic HF is also known as

Answer 23

congestive HF

Question 24

HF

LHF clinical features

Answer 24

• exertional dyspnea
• orthopnea
• Paroxysmal nocturnal dyspnea
• B/L fine crepts

Question 25

# HF why orthopnea in LHF

Answer 25

Abdominal organs will push the diaphragm + already SOB

Question 26

# HF Paroxysmal nocturnal dyspnea

Answer 26

getting up w cough during sleep

Question 27

# HF RHF clinical features

Answer 27

* elevated JVP * Tender hepatomegaly * B/L ankle edema * Ascites

Question 28

# HF RHF pathophysiology

Answer 28

* R/ ventricle pumping is reduced * Blood accumulates in the RV * Workload on the R/ atrium is high * Blood backup in the R/atrium. Pressure increases * Blood backup in the SVC and IVC. Pressure increases * Fluid leaks out giving fluid overload Sx

Question 29

# HF Underlying causes of Congestive HF

Answer 29

* IHD * Valvular heart disease * Long- term HTN * Cardiomyopathy

Question 30

# HF Ix for CHF

Answer 30

* ECG * 2D echo * BNP * CXR * FBC, LFT, BU, Sr.Cr

Question 31

# HF ECG findings

Answer 31

* evidence of ischemic changes - MI * arrhythmia * valvular heart disease

Question 32

# HF 2D echo findings

Answer 32

* size of the ventricles/ contractility * diastolic function * valve structure

Question 33

# HF Echo findings of diastolic failure

Answer 33

classical Sx of HF with preserved systolic function

Question 34

# HF ECG change in HF

Answer 34

poor R wave progression V1- V6

Question 35

# HF Echo findings with systolic failure

Answer 35

segmental wall motion abnormalities

Question 36

# HF THE IX for HF

Answer 36

BNP- brain natriuretic peptide

Question 37

# HF function of ANP, BNP

Answer 37

hormones that can cause Sodium and water removal

Question 38

# HF In Dx HF, Whats the most newer test

Answer 38

NT- Pro BNP

Question 39

# HF How can BNP Dx acute HF on top of chronic HF

Answer 39

BNP can Dx acute HF on top of chronic HF values will be very high. Report will come within hours.

Question 40

# HF CXR findings

Answer 40

* Upper lobe diversion * Kerley B lines * Batwing wing * Snow storm appearance

Question 41

# HF Upper lobe diversion

Answer 41

blood is diverted to the upper lobes

Question 42

# HF Kerley B lines

Answer 42

Fluid at the interstitium

Question 43

# HF Batwing sign

Answer 43

Fluid at the hilum

Question 44

# HF Snowstorm appearance

Answer 44

Fluid throughout the lung

Question 45

# HF HF pathophysiology

Answer 45

1. Increased sympathetic activity- Increased HR and Contractility 2. Activate RAAS- increased aldosterone, sodium and water retention 3. Cardiac remodelling- hypertrophy, dilatation **This is a viscious cycle and its bad long term**

Question 46

# HF Why do a FBC

Answer 46

Anemia can cause HF and worsen HF

Question 47

# HF Why do a LFT

Answer 47

HF can cause secondary liver failure. **Cardiac cirrhosis**

Question 48

# HF Why do a BU

Answer 48

HF can cause secondary renal failure. **cardio- renal Xd**

Question 49

# HF Mx of chronic HF

Answer 49

* weight reduction * dietary Mx * Lifestyle Mx * Vaccination * Drug Mx * Treat underlying cause * Surgical Mx * Device Mx

Question 50

# HF Dietary Mx

Answer 50

Salt restriction

Question 51

# HF Lifestyle Mx in HF

Answer 51

stop smoking, alcohol

Question 52

# HF Vaccinations given

Answer 52

* Haemophilus * Pneumococcal * Influenza

Question 54

# HF Drug Mx

Answer 54

* Frusemide * ACEI * beta Blockers * Spironolactone * Digoxin * Warfarin

Question 55

# HF Frusemide

Answer 55

Only Sx benefit, no mortality benefit

Question 56

# HF Best drug/ first line drug

Answer 56

ACEI, has a mortality benefit

Question 57

# HF The beta blockers used in HF

Answer 57

* Carvedilol * Metoprolol succinate * Bisoprolol

Question 58

# HF When to add spironolactone

Answer 58

When there's no response from ACEI and beta blockers

Question 58

# HF HF Drugs with a high mortality risk

Answer 58

Digoxin

Question 59

# HF Drugs that can increase mortality benefit

Answer 59

* ACEI * Beta blockers * Spironolactone * Ivabradine * Sacubutril valsartan

Question 60

# HF When is digoxin given

Answer 60

used in HF with AF or in HF not responding to other drugs

Question 61

# HF When is warfarin given

Answer 61

* When ejection fraction is very low * LV aneurysm * A-fib

Question 62

# HF ARNIs

Answer 62

* sacubutril valsartan * Ivabradine

Question 63

# HF Surgical Mx

Answer 63

* Revascularization * valve replacement * aneurysectomy

Question 64

# HF Device Mx in HF

Answer 64

* Implanntable cardiac defibrillators * cardiac resync therapy * Combined ICD+ CRT

Question 65

# HF besides meds what else has a mortality benefit in HF Mx

Answer 65

* Surgical Mx * Device Mx

Question 66

# HF If the pt cannot tolerate ACEI, what to give

Answer 66

ARBs. But normally ACEI is the best

Question 67

# HF V1- V4

Answer 67

Anterior surface

Question 68

# HF V3, V4

Answer 68

septum

Question 69

# HF aVL, V5

Answer 69

lateral

Question 70

# HF III, II, aVL

Answer 70

inferior surface