Heart Failure

Question 1

What is Congestive Cardiac Failure due to?

Answer 1

low cardiac output (in most cases)

Question 2

Why does low cardiac output cause issues?

Answer 2

It causes the kidney to be under perfused so it retains salt and water
Retained salt and water makes breathlessness worse

Question 3

What are the two types of Heart Failure?

Answer 3

Acute

Chronic

Question 4

What can cause Left sided HF?

Answer 4

Ischaemic heart disease
MIs
cardiomyopathy
valvular disease

Question 5

What can cause Right sided HF?

Answer 5

secondary to left side
congenital heart disease
cor pulmonale

Question 6

What are the symptoms of HF?

Answer 6

Dyspnoea on exertion/rest
Orthopnoea – breathless when lying flat
Paroxysmal nocturnal dyspnoea
Pulmonary oedema (sudden dyspnoea pink, frothy sputum)

Question 7

What can Orthopnoea also be a sign of?

Answer 7

Asthma

Question 8

What are Left Ventricular HF clinical signs?

Answer 8

Tachycardia
Fine crepitations – fluid retained in the lungs
Pleural effusion
3rd heart sound (Gallop rhythm = S3 + Tachycardia)

Question 9

How does Left HF look on a CXR?

Answer 9

Cardiomegaly – to compensate
Bats wing shadows esp. lower zones
Interstitial fluid

Question 10

What is the symptom of Right HF?

Answer 10

Oedema

Question 11

What are the signs of Right HF?

Answer 11

Oedema (ankle/sacral)
JVP elevated (>4cm above sternal angle)
Hepatomegaly
Ascites (fluid in abdomen)

Question 12

What does Right HF look like on a CXR?

Answer 12

Normal

Question 13

What is the first line standard treatment for CCF?

Answer 13

• Diuretics to excrete retained fluid
• Angiotensin converting enzyme inhibitors
• Beta Blockers (caution required)
• Spironolactone (severe cases only)

Question 14

What is the second line standard treatment for CCF?

Answer 14

Digoxin
Other vasodilators (nitrates, hydralazine)

Question 15

What is the third line standard treatment for CCF?

Answer 15

Implantable Cardiac Defibrillators
Cardiac Resynchronisation Therapy
Transplantation

Question 16

When CCF is caused by Cor Pulmonale, what is the treatment?

Answer 16

Diuretics and Oxygen

Question 17

When CCF is caused by Valvular Disease, what is the treatment?

Answer 17

Surgery

Question 18

When CCF is caused by Fast AF, what is the treatment?

Answer 18

DC Shock

Digoxin

Question 19

What are the names of the Diuretics used to treat CCF?

Answer 19

thiazide diuretics - only for mild CCF
loop diuretics (furosemide)

Question 20

What are the names of the ACE Inhibitors used to treat CCF?

Answer 20

Captopril
Enalapril
Lisinopril

Question 21

What are the side effects of ACE inhibitors?

Answer 21

Angioneurotic oedema (Life threatening but rare)
First dose causes hypotension esp. if serum Na low
Renal Impairment – UE must be monitored after AECI begun
Cough

Question 22

When would you substitute an ACE with an ARB?

Answer 22

When the patient has a cough

Question 23

What are the names of the Beta Blockers used to treat CCF?

Answer 23

Bisoprolol (β1 selective)

Carvedilol (Non-selective plus alpha blockade)

Question 24

What are the side effects of Beta Blockers?

Answer 24

Hypotension

Worsening Dysponoea

Question 25

Which drugs increase potassium levels?

Answer 25

Spironolactone and ACE inhibitors

Question 26

When is Spironolactone used in CCF?

Answer 26

in moderate to severe cases, along with an ACE inhibitor

Question 27

What are the side effects of Spirononlactone?

Answer 27

Hyperkalaemiat Renal Dysfunction Gynaecomastia – breast growth in men

Question 28

When would you use Ivabradine in CCF?

Answer 28

When patients hert rate is not slowing, even on BBlockers or if the patient cannot take BBlockers

Question 29

What is Sacubitril-Valsartan?

Answer 29

Combination of ARB and Neprilysin Inhibitor | - blocks natriuretic peptide breakdown and boosts natriuretic peptide (BNP) levels

Question 30

Why must an ACE inhibitor and Sacubitril-Valsartan not be used together?

Answer 30

the same life threatening side effect which is Angioneurotic oedema

Question 31

What is bundle branch block?

Answer 31

right ventricle and left ventricle don’t contract at the exact same millisecond

Question 32

When is Digoxin used?

Answer 32

Excellent therapy for AF | Mediocre therapy for CCF in sinus rhythm

Question 33

What are the side effects of Digoxin?

Answer 33

Nausea, vomiting Bradycardia, Heart Block (pacemaker needed) Sudden death as it can produce any arrhythmia

Question 34

What are the 5 steps of acute Left HF therapy?

Answer 34

1. Sit patient up – so gravity shifts fluid away from the lungs 2. Oxygen (care in COPD) 3. Intravenous Furosemide 4. Intravenous Diamorphine (not in COPD) 5. Intravenous Nitrates