Heart failure

Question 1

what is plasma BNP and whats it related to?

Answer 1

B-type natriuretic peptide
polypeptide secreted by the ventricles of the heart in response to excessive stretching of cardiomyocytes
secreted from the ventricular myocardium + closely related to LV pressure
In MI and LV failure, can be released in large quantities

Question 2

Heart failure

Answer 2

CO inadequate for body’s requirements

Need to have:

1. signs + symptoms typical of HF
2. objective evidence of an abnormality of the structure or function of the heart at rest

Question 3

Systolic failure

Answer 3

inability of the ventricle to contract normally, resulting in decreased CO

EF

Question 4

Diastolic failure

Answer 4

inability of ventricle to relax and fill normally
raised filling pressures
decreased preload
EF >50% (normal/near normal)

Question 5

Causes of systolic HF

Answer 5

IHD, MI, cardiomyopathy

Question 6

Causes of diastolic HF

Answer 6

tamponade, constrictive pericarditis, HTN

Question 7

What is congestive cardiac failure?

Answer 7

Left ventricular failure and right ventricular failure existing together

Question 8

Symptoms of left heart failure (LVF)

Answer 8

Exertion dyspnoea
Paroxysmal nocturnal dyspnoea (PND)
Orthopnoea (dyspnoea when lying flat)
Fatigue
Nocturnal cough

Question 9

Symptoms of right-sided heart failure (RVF)

Answer 9

Peripheral oedema (ankles, sacrum)
Ascites
Nausea
Facial engorgement (filling)
Fatigue
Anorexia

Question 10

Causes of left heart failure

Answer 10

IHD
Valvular disease
HTN

Question 11

Causes of right heart failure

Answer 11

LVF
Pulmonary stenosis
Lung disease

Question 12

Acute HF

Answer 12

New onset acute or decompensation of chronic heart failure characterised by pulmonary and/or peripheral oedema with or without signs of peripheral hypo perfusion

Question 13

Chronic HF

Answer 13

develops or progresses slowly
venous congestion is common
arterial pressure well maintained until very late

Question 14

Low output heart failure

Answer 14

CO is decreased and fails to increase normally with exertion

Question 15

Causes of low output heart failure

Answer 15

Pump failure: systolic & diastolic HF, -ve inotropic drugs (most antiarrhythmics)
Excessive preload: mitral regurgitation, fluid overload
Chronic excessive after load: aortic stenosis, HTN

Question 16

Whats high output HF?

Answer 16

rare, normal output: but increased needs

causes: anaemia, pregnancy, hyperthyroidism, paget’s disease

Question 17

Criteria name for diagnosis of congestive cardiac failure?

Answer 17

Framingham criteria

Question 18

ABCDE for CXR in left ventricular failure

Answer 18

A - Alveolar oedema ('Bat's' wings)
B - Kerley B lines (insterstial oedema)
C - cardiomegaly
D - Dilated prominent upper lobe vessels
E - pleural effusion

Question 19

LHF signs

Answer 19

cardiomegaly
3rd & 4th heart sounds
tachycardia
crepitations in lung bases
pleural effusion

Question 20

RHF signs

Answer 20

raised JVP
hepatomegaly
pitting oedema
ascites

Question 21

Other signs of HF

Answer 21

exhaustion, cool peripheries, cyanosis, low BP…

Question 22

HF investigations

Answer 22

ECG - may indicate cause
BNP

if either is abnormal –> echo
(if both normal: HF unlikely)

CXR
Bloods

Question 23

Chronic HF management

Answer 23

Stop smoking, lower salt intake, optimise weight + nutrition

treat cause
treat exacerbating factors
avoid exacerbating factors (e.g. NSAIDs - fluid retention)

Question 24

A loop diuretic for chronic HF management

Answer 24

furosemide

Question 25

An ACE-i for chronic HF management

Answer 25

ramipril

Question 26

an ARB

Answer 26

Candesartan | candy and tartan

Question 27

A beta-blocker

Answer 27

Carvedilol

Question 28

What is spironolactone?

Answer 28

an aldosterone antagonist

Question 29

Name 2 vasodilators

Answer 29

Hydrazine & isosorbide dinitrate (HID)

Question 30

Acute HF management

Answer 30

``` oxygen monitor ECG - treat any arrhythmias Diamorphine IV Furosemide IV GTN spray ```

Question 31

LOON pneumonic for acute HF management

Answer 31

Loop diuretic (furosemide) Oxygen Opiod (diamorphine) Nitrates (GTN)

Question 32

Complications of HF

Answer 32

``` renal failure (as not perfusing kidney properly) hepatic dysfunction arrhythmia ```

Question 33

What is the NYHA?

Answer 33

New York Heart Association Classification Relies on functional class. What the pt can do without getting heavy or tired

Question 34

Classes I - IV of the NYHA

Answer 34

I: no limitation (asymptomatic) II: slight limitation (mild HF) III: marked limitation (moderate HF) IV: inability to carry out any physical activity without discomfort (severe HF)

Question 35

What does Ivabradine do?

Answer 35

blocker of the If current in the SA node slows sinus node rate agent for treating angina (iv a brad - housemate)

Question 36

What to do if HF with preserved LV EF?

Answer 36

give diuretics to deal with confession | treat any cardiovascular problem

Question 37

Surgery and HF

Answer 37

mitral valve repair aortic valve replacement mitral valve replacement LV re-modelling

Question 38

When would you use an ARB?

Answer 38

if an ACE-i is contraindicated or due to side effects