Heart Failure

Question 1

Management of heart failure?

Answer 1

Conservative: weight loss, smoking cessation, exercise, salt and fluid restriction, offer annual flu and one off pneumococcal vaccine

Loop diuretics with…
- 1st line - ACEi/ARB/hydralazine + Beta Blocker
-** 2nd line** - add aldosterone antagonist, SGLT2 inhibitor
- 3rd line - add ivabradine if in sinus rhythm + reduced EF, sacubitril-valsartan, hydralazine + nitrate if Black, digoxin in AF, cardiac resynchronisation therapy

Question 2

Causes of systolic heart failure?

Answer 2

Ischaemia to heart
Dilated cardiomyopathy
Sarcoidosis
Haemachromatosis
Myocarditis

Question 3

Causes of diastolic heart failure?

Answer 3

hypertrophic cardiomyopathy, cardiac tamponade, pericarditis

Question 4

What is normal ejection fraction?

What is reduced ejection fraction?

Answer 4

Normal = 50-70%

Reduced

Question 5

Management of Acute heart failure?

Answer 5

IV furosemide/bumetanide

Sats below 94% → oxygen

Hypertensive → vasodilators e.g. ACEi to improve blood flow to heart

If respiratory failure → give CPAP

If hypotensive/cardiogenic shock → inotropic agents, vasopressors, mechanical circulatory assistance

Question 6

Investigations for heart failure?

Answer 6

NT‑proBNP blood test
FBC - anaemia
U&Es for renal function
TFTs for thyroid function
Lipid profile
HbA1c
ECG
Echocardiogram
CXR and lung function tests to exclude lung cancer

Question 7

Top causes of heart disease

Answer 7

1. Ischaemic heart disease
2. Hypertension
3. Valvular disease

Question 8

Indications for cardiology referral for heart failure?

Answer 8

NTProBNP result
400-2000 = see within 6 weeks in cardiology for echo
Above 2000 = see within 2 weeks for echo

Question 9

What must you monitor when on diuretics, ACE inhibitors and aldosterone antagonists?

Answer 9

U&Es as they can cause electrolyte imbalance

Question 10

What must you monitor with ACE inhibitors and aldosterone antagonists

Answer 10

U&Es for renal function, and the drugs may cause hyperkalaemia