Heart failure

Question 1

what is the first line treatment for heart failure?

Answer 1

beta blocker + ACE inhibitor

start one for 2 weeks then add on the other
if you start 2 at the same time then causes severe hypotension

Question 2

what is the 2nd line treatment for heart failure?

Answer 2

aldosterone antagonist e.g. spironolactone

Question 3

what is the 3rd line treatment options for heart failure?

Answer 3

digoxin 
ivabradine 
sacubitril valsartan 
cardiac resynchronisation 
cardiac ICD

Question 4

what are the indications for ivabradine in the treatment of heart failure?

Answer 4

3rd line option if sinus rhythm with HR > 75

LVEF < 35%

Question 5

what are the indications for digoxin in the treatment of heart failure?

Answer 5

3rd line if co-existing AF

Question 6

what are the indications for sacubitril valsartan in the treatment of heart failure?

Answer 6

3rd line if LVEF < 35% and HR < 75 bpm

Question 7

what are the indications for cardiac resynchornisation in the treatment of heart failure?

Answer 7

3rd line option if LVEF < 35%, been on a few medications and prolonged QRS (LBBB)

Question 8

when would a patient with heart failure be put on long term 02?

Answer 8

if Pa02 < 7.3 / 53mmHg

Question 9

what is the long term management of heart failure?

Answer 9

once off pneumococcal vaccine

annual influenza vaccine

Question 10

what investigations would you carry out if a patient presented with signs of heart failure?

Answer 10

BNP
12 lead ECG
bloods;
- FBC, U&E, TFT

trans thoracic ECHO
CXR

Question 11

what are features on CXR of heart failure?

Answer 11

alveolar oedema
kersey B lines
cardiomegaly 
diffuse upper lobe vessels 
pleural effusion

Question 12

at what BNP level is abnormal?

Answer 12

> 100 mol/L

Question 13

at what BNP level is an echo arranged?

Answer 13

> 100 - abnormal
200 - within 6 weeks
400 - within 2 weeks
acute heart failure -urgent

Question 14

what are signs of heart failure eon clinical examination?

Answer 14

peripheral oedema
elevated JVP 
hepatomegaly 
3rd heart sound/S3 ventricular gallop 
bibasal crackles

Question 15

what are the symptoms of heart failure?

Answer 15

paroxysmal nocturnal dyspnoea 
orthopnoea 
dyspnoea 
cough - pink sputum, worse at night 
swollen ankles 
weight loss - cardiac cachexia 
fatigue 
wheee

Question 16

what is the classification of heart failure?

Answer 16

NYHA classification
I - asymptomatic
II - symptomatic during physical exercise
III - symptomatic with less than ordinary physical activity
IV - symptomatic at rest

Question 17

if a patient presents with an acute presentation of heart failure with significant breathlessness, what is the 1st line treatment?

Answer 17

IV furosemide

Question 18

when is an ICD preferred for treatment of heart failure?

Answer 18

risk of sudden cardiac failure or life threatening arrhythmia
- LVEF < 30% and prolonged QRS > 120ms

Question 19

describe the pathophysiology of heart failure?

Answer 19

as volume of left ventricle increases, the cardiac output increases
but when this increases too much it plataus as the heart cannot cope
results in fluid backing up in the pulmonary circulation and reduced cardiac output
neurohormonal mechanisms e.g. RAAS increase in response to decreased cardiac output causing peripheral vasoconstriction and fluid retention making the situation worse

Question 20

why does BNP rise in heart failure?

Answer 20

rises in response to stretching of the ventricular myocytes