Heart Failure

Question 1

Symptoms of HF

Answer 1

Breathlessness
Fatigue
Tiredness
Ankle Oedema

Question 2

Signs of HF

Answer 2

Tachycardia
Tachypnoea
Pulmonary effusion
Crackles
Raised JVP
Peripheral Oedema
Hepatomegaly
Third Heart Sound
Cardiomegaly
Murmurs

Question 3

Systolic HF

Answer 3

HF with reduced ejection fraction <40%

Question 4

Diastolic HF

Answer 4

HF with preserved ejection fraction >40%

Question 5

Left Heart Failure

Answer 5

Congestion of the pulmonary veins
Fluid Retention
Pulmonary Oedema

Question 6

Right Heart Fialure

Answer 6

Congestion of systemic veins
Fluid retention
Peripheral Oedema

Question 7

Aetiology of HF

Answer 7

Hypertension
Coronary Artery Disease
Valvular Heart Disease
Cardiomyopathies
Congenital Heart Disease
DM
Alcohol Tobacco
Cocaine
OSA

Question 8

What is High output Heart Failure?

Answer 8

Heart is working normally but the needs of the body are higher than what the heart can supply

Question 9

What Conditions cause high output HF?

Answer 9

Hyperthyroidism
Anaemia
Paget’s disease
AV malformation

Question 10

Frank Starling Mechanism

Answer 10

Preload
Pump Failure
Chronic excessive afterload

Question 11

Examples of Increased Preload

Answer 11

Mitral regurgitation

Fluid overload

Question 12

Examples of Pump Failure

Answer 12

IHD
Cardiomyopathy
Constrictive pericarditis
Cardiac tamponade
Heart block
Post-MI
AF
Negatively inotropic drugs: verapamil, diltiazem

Question 13

Examples of chronic excessive afterload

Answer 13

Hypertension

Aortic Stenosis

Question 14

Investigations

Answer 14

U: Urinalysis
B: U+Es, Creatinine, FBC, TFTs, LFTs, glucose, lipids, BNP
E: 12 lead ECG
I: Chest X Ray, Echocardiography
S: Peak flow, spirometry

Question 15

HF findings on CXR

Answer 15

Alveolar Oedema
Prominent Upper Lobe Vessels
Bat's wings
Kerley B lines
Pleural effusions

Question 16

How to confirm the diagnosis of HF?

Answer 16

Echocardiography

Question 17

NYHA I

Answer 17

No limitation, physical exercise does not cause symptoms

Question 18

NYHA II

Answer 18

Slight limitation of physical activity

Question 19

NYHA III

Answer 19

Marked limitation of physical activity

Question 20

NYHA IV

Answer 20

Unable to carry out any physical activity without discomfort

Question 21

Conservative management of HF

Answer 21

Risk Factor Management
Education
Decrease salt
Decrease weight
Restrict alcohol
Restrict fluid intake
Pneumococcal and annual influenza vaccination

Question 22

Drugs for HF w/ Reduced EF

Answer 22

ACE inhibitors
Beta Blockers
Diuretics if fluid overloaded

Question 23

Drugs for HF w/ Preserved EF

Answer 23

Diuretics

No specific treatment

Question 24

Examples of Loop diuretics

Answer 24

Furosemide

Bumetanide

Question 25

Management of HF and AF/ history of thromboembolism

Answer 25

Anticoagulation

Question 26

CI to Beta Blockers

Answer 26

Severe asthma
2nd/3rd degree AV block
Sick Sinus Syndrome
Phaeochromocytoma
Cocaine use

Question 27

When to consider Digoxin?

Answer 27

Worsening HF

Question 28

When to consider ivabradine?

Answer 28

LV ejection fraction <35% and HR >75bpm

Question 29

When to consider sacubatril/valsartan?

Answer 29

If on ACE-I and ARB and EF <35%

Question 30

When to consider hydralazine + nitrate?

Answer 30

If Afro-Caribbean and moderate to severe CHF

Question 31

How does ACE-I work to slow the progression of cardiac remodelling

Answer 31

Causes vasodilation
Decreases preload and afterload
Decreases cardiac work
Increases Cardiac Output