Heart failure

Question 1

What is the calculation used to determine cardiac output?

Answer 1

Heart rate x stroke volume

Question 2

Dysfunction of which valves may lead to left heart failure?

Answer 2

Aortic

Mitral

Question 3

Dysfunction of which valves may lead to right heart failure?

Answer 3

Tricuspid

Pulmonary

Question 4

Recall some lung causes of right heart failure

Answer 4

Pulmonary: HTN/ embolus

Chronic lung disease

Question 5

What is cor pulmonale?

Answer 5

Enlargement and failure of the right ventricle due to increased pressure in the lungs/ vascular resistance

Question 6

Recall a mnemonic for and the causes of a higher cardiac output state being required

Answer 6

NAP MEALS
Nutritional - vit B1 deficiency
Anaemia
Pregnancy
Multiple myeloma
Endocrine (hyperthroidism)
AV malformations
Liver cirrhosis
Sepsis

Question 7

What is congestive heart failure?

Answer 7

mixture of RHF and LHF

Question 8

Why does LHF cause symptoms?

Answer 8

LHF –> blood backflow –> fluid buildup in the lungs –> respiratory symptoms

Question 9

Recall 4 symptoms of LEFT heart failure

Answer 9

1. Exertional dyspnoea
2. Paroxysmal nocturnal dyspnoea
3. Orthopnoea
4. Nocturnal cough - may have PINK FROTHY sputum

Question 10

What is an S3 heart sound caused by?

Answer 10

A sudden deceleration of blood flow into the left ventricle from the left atrium

Question 11

What is a “gallop rhythm”?

Answer 11

Presence of S1 + S2 + S3 heart sounds

Question 12

Recall 5 signs that may be identified on examination of the heart in LEFT heart failure?

Answer 12

Tachycardia
Displaced apex beat
Irregularly irregular pulse
Gallop rhythm
Murmur

Question 13

Recall 2 lung signs that may be identified in LHF

Answer 13

Bibasal crackles

Wheeze

Question 14

How does RHF cause symptoms?

Answer 14

Results in systemic fluid congestion –> peripheral symptoms

Question 15

Describe the symptoms of RHF

Answer 15

All the vowels: 
Ascites
Exercise tolerance reduced
Increased urinary frequency
Oedema - ankles and face
Under-eating

Question 16

Which type of heart failure causes a raised JVP?

Answer 16

RHF

Question 17

What 2 signs may be identified o/e of the heart in RHF?

Answer 17

Parasternal heave

Tricuspid regurgitation

Question 18

What signs may be seen in the abdomen in RHF?

Answer 18

Ascites and hepatomegaly

Question 19

Pitting oedema in ankles/ sacrum is a sign of what sort of heart failure?

Answer 19

RHF

Question 20

Which serum marker has a high negative predictive value for indicating heart failure?

Answer 20

BNP (brain natiuretic peptide)

Question 21

What is the calculation used to determine ejection fraction?

Answer 21

Stroke volume/ End diastolic volume

Question 22

What is a normal ejection fraction?

Answer 22

50-70%

Question 23

What does an ejection fraction above 50% in the presence of heart failure symptoms indicate?

Answer 23

Heart failure with preserved ejection fraction = abnormal diastolic function

Question 24

Recall 2 elements of heart function that are decreased in systolic heart failure, and how systolic heart failure is defined

Answer 24

Stroke volume + strength of contraction

SHF = EF < 40%

Question 25

Recall the features of heart failure on CXR

Answer 25

``` ABCDE Alveolar oedema B-lines (kerley) Cardiomegaly Dilated upper lobe vessels Effusion ```

Question 26

What do dilated upper lobe vessels on CXR indicate?

Answer 26

Pulmonary venous HTN

Question 27

How do you identify pleural effusion on CXR?

Answer 27

Blunting of costophrenic angle

Question 28

Recall the management of acute heart failure

Answer 28

``` IV access and ECG Sit patient up Morphine 2.5mg IF in pain (nb is 10mg in MI) Oxygen Nitrate - GTN 2 puffs sublingual Diuretic (IV furosemide) ```

Question 29

Atrial fibrillation is associated with which murmur?

Answer 29

Mitral stenosis