Heart Failure

Question 1

HF

Answer 1

A cardiac disorder that prohibits delivery of sufficient output to meet the perfusion requirements of metabolising tissues

Question 2

HF Causes

Answer 2

Coronary artery disease
Hypertension
Cardiomyopathy
Valvular heart disease

Question 3

HF aggravating factors

Answer 3

Cardiac arrhythmias
Hypertension
Anaemia
Infections

Question 4

HF effect

Answer 4

Decreased Cardiac Output (peripheral hypoperfusion)
Fluid retention (congestion)
Increased sympathetic NS

Question 5

HF Symptoms

Answer 5

Fatigue
Dyspnoea
Oedema

Question 6

HF Signs

Answer 6

Skin cold to touch
Basal crackles 
Increased JVP
Ankle oedema
Ascites
Tachycardia
Sweating
Pulsus alternans

Question 7

HF Complications

Answer 7

Intravascular thrombosis
Infection
Functional valvular dysfunction
Multi-organ failure
Cardiac arrhythmias
Sudden death

Question 8

Intravascular thrombosis

Answer 8

PE

Systemic embolism

Question 9

Infection

Answer 9

Chest

Ulcerated cellulitis legs

Question 10

Multi-organ failure

Answer 10

Renal

Liver

Question 11

HF Diagnosis

Answer 11

BNP
ECG
Chest X Rays
Echo

Question 12

BNP RELEASE

Answer 12

Secreted by myocardial cells in response to raised left atrial pressure

Question 13

BNP effect

Answer 13

Promotes natriuresis and vasodilation

Inhibits ADH and aldosterone release

Question 14

BNP Levels

Answer 14

Levels >100pg/ml indicate heart disease

–> likely cause of dyspnoea and fluid retention

Question 15

HF ECG

Answer 15

Never normal
Inferior Q waves
Ectopic firing
Left BBB

Question 16

HF Chest X rays

Answer 16

Pulmonary congestion

Pulmonary oedema

Question 17

HF Echo

Answer 17

LV huge

Question 18

HF Treatment

Answer 18

Treat both systolic and diastolic failure

Question 19

Systolic failure treatment

Answer 19

ACE inhibitors
Beta Blockers
Spironolactone
CRT (cardiac resynchronisation therapy)
Angiotensin receptor neprilysin inhibitor

Question 20

Cardiac resynchronisation therapy

Answer 20

Patient in sinus rhythm (no AF)
LVEF <35%
QRS prolongation required (usually left BBB)– >150msec, or >120 msec + mechanical dyssynchrony

Question 21

Heart transplant

Answer 21

80% 1 year survival

Question 22

Heart transplant indications

Answer 22

Resistant CCF without:

- major organ failure, major co-morbidity, psychological disability, severe pulmonary hypertension

Question 23

Diastolic failure

Answer 23

Heart failure with normal ejection fracture

Impaired LV filling due to increased chamber stiffness +/or decreased relaxation

Question 24

Diastolic failure epidemiology

Answer 24

Women more common
Older people
50% HF in adults

Question 25

Diastolic failure treatment

Answer 25

Treat underlying cause, especially hypertension Treat systolic failure if mixed Treat fluid retention

Question 26

Acute HF Causes

Answer 26

Acute MI Cardiac tachyarrhythmia Valvular heat disease- mitral stenosis

Question 27

Acute HF clinical presentation

Answer 27

Pulmonary oedema --> severe dyspnoea Desaturation --> central cyanosis Reduced CO --> cool skin, peripheral cyanosis Symp. activation --> tachycardia, sweating Other findings --> S3, pulsus alternans

Question 28

Acute HF Immediate treatment

Answer 28

Treat aggravating factors Correct pulmonary oedema Correct desaturation

Question 29

Support LV

Answer 29

Pharmacological support --> inotropes | Mechanical support--> balloon pump, LVAD

Question 30

Support kidneys

Answer 30

ultrafiltration/dialysis

Question 31

HF Aggravating factors

Answer 31

Cardiac arrhythmias- AF Hypertension Anaemia Chest infection

Question 32

Implantable Defibrillator

Answer 32

AMI > 4 weeks previously | LV ejection fraction >30% and QRS <120msec