Heart Failure

Question 1

What is heart failure also referred to as?

Answer 1

Congestive cardiac failure

Question 2

What is heart failure caused by?

Answer 2

Low cardiac output

Question 3

What are the types of heart failure?

Answer 3

• LVF
• RVF
• mixed

Question 4

What are the main causes of LVF?

Answer 4

• interstitial disease especially previous MIs
• cardiomyopathy
• valvular disease

Question 5

Why do previous MIs cause LVF?

Answer 5

-when have an MI and some of the muscle dies off then that causes scarring which means the ventricle cant contract very well

Question 6

What causes RVF?

Answer 6

• LVF
• Cor pulmonale
• congenital heart disease

Question 7

What are the symptoms of LVF?

Answer 7

• dyspnoea on exertion/rest
• orthopnoea
• paroxysmal nocturnal dyspnoea
• pulmonary oedema

Question 8

What are the signs of LVF?

Answer 8

• tachycardia
• fine crepitation
• pleural effusion
• 3rd heart sound

Question 9

What do you get if you mix the third heart sound with tachycardia?

Answer 9

galloping

Question 10

What do you see on a CXR in LVF?

Answer 10

• cardiomegaly
• bats wing shadows on lower zones
• interstitial fluid

Question 11

What is another cause of pleural effusions?

Answer 11

lung cancer

Question 12

What are the symptoms of RVF?

Answer 12

oedema

Question 13

What are the signs of RVF?

Answer 13

• oedema
• elevated JVP
• hepatomegaly
• ascites

Question 14

What would you see on a CXR in RVF?

Answer 14

normal usually since you dont see the R side on CXR most the time

Question 15

In which causes for HF is standard medical therapy for HF used?

Answer 15

• Previous Mis

- Cardiomyopathies

Question 16

What is the specific therapy used for HF caused by cor pulmonale?

Answer 16

-Rx diuretics and oxygen only

Question 17

What is the specific therapy used for HF caused by valvular disease?

Answer 17

-surgery ideally (valve replacement)

Question 18

What is the specific therapy used for HF caused by fast AF?

Answer 18

Digoxin or DC shock

Question 19

What is the most commonly used standard medical treatment for CCF?

Answer 19

• diuretics
• ACEI
• Bblockers
• spironolactone

Question 20

What can also be considered standard medical treatment for CCF?

Answer 20

• digoxin
• other vasodilators
• implantable cardiac defibrillators
• cardiac resynchronisation therapy
• transplantation

Question 21

Which diuretic is preferred in CCF?

Answer 21

loop diuretics

Question 22

What is one of the side effects of furosemide?

Answer 22

lose potassium

Question 23

How can the loss of potassium be regained?

Answer 23

use of furosemide alongside ACEI and spiralactone which increase K

Question 24

What is one of the most undesired side effects of spiralactone?

Answer 24

Gynaecomastia - reduces the male hormones in men causing moobs. Reduces female hormones in women as well

Question 25

What does ivabradine do?

Answer 25

slows HR in sinus rhythm and is useful in people who cant take B Blockers such as asthmatics. Also can be used in angina

Question 26

What is sacubitruil-valsartan?

Answer 26

combination of ARB and Neprilysin Inhibitor

Question 27

What does Neprilysin Inhibitors do?

Answer 27

blocks natriuretic peptide breakdown and boosts natriuretic peptide levels

Question 28

What could sacubitruil-valsartan replace in the future?

Answer 28

ACEIs

Question 29

What is a side effect of sacubitruil-valsartan

Answer 29

angioneurotic oedema

Question 30

What must you not use sacubitruil-valsartan alongside?

Answer 30

ACEI, must jeep 48h between use of each

Question 31

What is the advantage of cardiac resynchronisation therapy?

Answer 31

3 pacemakers inserted to force LV and RV to contract together at same time.

Question 32

What do normal pacemakers do?

Answer 32

stimulate only the right side of the heart

Question 33

When do we use cardiac resynchronisation therapy?

Answer 33

in prolonged QRS and bundle branch block

Question 34

What si the acute LVF therapy?

Answer 34

- sit up - oxygen (careful in COPD) - intravenous furosemide - intravenous diamorphine (not in COPD) - Intravenous nitrates