Heart Failure

Question 1

What are the 3 types of heart failure you can get?

Answer 1

Right sided
Left sided
Mixed (both)
Slide 2

Question 2

What are the usual causes for left sided heart failure?

Answer 2

Ischaemic heart disaese due to MI
Cardiomyopathy
Valvular disease.
Slide 3

Question 3

What are the usual causes for right sided heart failure?

Answer 3

Can be secondary to left heart failure.
Cor pulmonale
Congenital.
Slide 3

Question 4

What are the signs and symptoms of LVF?

Answer 4

Symptoms: Dyspnoea, orthopnoea, PND, pulmonary oedema (pink, forthy sputum)
Signs: Tachycardia, fine crepitations, pleural effusion, addition of 3rd heart sound.
CXR:
Cardiomegaly
Interstitial fluid.
Slide 4+5

Question 5

What are the symptoms and signs of Right heart failure?

Answer 5

Symptoms: Oedema
Signs: Oedema (ankle,sacral), elevation JVP, hepatomegaly, ascites.
CXR: Normal.
Slide 6

Question 6

What is the specific treatment for Cor pulmonale?

Answer 6

Rx diuretics and oxygen only. Slide 7

Question 7

What is the specific therapy for fast AF?

Answer 7

Digoxin or DC shock. Slide 7

Question 8

What is the standard drugs given to CCF patients?

Answer 8

Diuretics
ACE inihibitors
B blockers (caution)
Spironolactone (severe)
Slide 8

Question 9

For patients with CCF what is the benifit of them being on ACE inhibitors and a diuretic?

Answer 9

Apart from the symptomatic releif, diuretics cause loss of K, where as ACE inhibitors retain K, so balances out. Slide 9

Question 10

What are the side effects of ACE Inhibitors?

Answer 10

Angioneurotic oedema
Hypotension
Renal impairment
Cough. Slide 10

Question 11

What do ARB drugs end in?

Answer 11

‘-artan’ suhc as losartan. Slide 11

Question 12

What is the effect of B blockers short term on CCF patients and what are the side effects?

Answer 12

Can worsen CCF short term and causes worsening dyspnoea short term. Slide 12

Question 13

What is spironolactone and what are the side effects?

Answer 13

Alsoterone receptor antagonist.
Hyperkalaemia (as they retain K)
Renal Dysfunction
Gynaecomastia (enlarged breast tissue for men)
Slide 13

Question 14

What is Sacubitril-Valsartan?

Answer 14

Combination of an ARB and neprilysin inhibitor.

Sacubitril blocks Natriuretic peptide breakdown. Slide 15

Question 15

What do you have to be careful about using Sacubitril-Valsartan?

Answer 15

They also cause angioneurotic oedema, so cannot administer along with an ACE inhibitor. Slide 15

Question 16

What are therapies for CCF?

Answer 16

Implantable cardiac defibrillator

Cardiac resynchronisation therapy.

Question 17

What patients can recieve Cardiac resynchronisation therapy?

Answer 17

Patients with bundle branch block. Slide 16

Question 18

What is the danger of digoxin?

Answer 18

It is excreted very slowly.

1/3 is excreted each day and has a very anrrow therapeutic window. Slide 17

Question 19

If there is high doses of digoxin, what can its effect be on the ventricle?

Answer 19

Can irritate it and cause ventricular arrhythmias. Slide 18

Question 20

What is the possible therapy for acute LVF?

Answer 20

Sit them up
O2 (mind if they have COPD)
IV furosemide
\+/- IV diamorphine (mind COPD patients)
\+/- IV nitrates
Slide 19