Heart Failure

Question 1

Differentiate between diastolic and systolic sided heart failure

Answer 1

Diastolic heart failure - problem with actually loading the heart with blood
Hence the normal ejection fraction

Systolic heart failure - problem with getting the blood out of the heart

Question 2

Give some causes of systolic heart failure

Answer 2

Ischemic heart disease incl. atherosclerosis
Chronic HTN
Dilated cardiomyopathy

Question 3

Give causes of diastolic heart failure

Answer 3

Aortic stenosis

Question 4

Name a drug that can cause heart failure if started too quickly at a high dose

Answer 4

Levothyroxine

Question 5

How can you classify heart failure?

Answer 5

Acute and chronic

Question 6

Epidemiology

Answer 6

1-3% general population
10% of elderly
50% mortality
Worse in south of london

Question 7

Causes of HF

Answer 7

Cardiomyopathy 
Congential defects 
MI
Arrhthymia 
HTN
Valve disease 
Lung fibrosis
Pulmonary atresia 
Vessel stenosis
PE (acute HF)
Myocarditis
Diabetes (HTN, HF)

Question 8

What is pulmonary atresia?

Answer 8

Narrowing pulmonary artery/trunk

Question 9

What are the consequences of

Answer 9

Heart works harder, hence HTN

pumps faster, hence tachycardia

Question 10

Why do you get pulmonary oedema?

Answer 10

The fluid from the pulmonary artery and vein (backflow from mitral regurg) goes into the lungs !!

Question 11

What is a consequence of right hypertrophy?

Answer 11

induced tricuspid regurg

and therefore blood goes back via IVC into LEGS

Question 12

Why do you get cachexia and atrophy?

Answer 12

The muscles aren’t used as a result of reduced perfusion due to HF, so the muscles waste away

Question 13

Nocturnal cough can be caused by?

Answer 13

Asthma

HF

Question 14

Is the nocturnal cough productive or non productive in HF?

Answer 14

Productive - pink and frothy because of pulmonary oedema

Question 15

Signs of LHF?

Answer 15

Cyanosis 
Poor exercise tolerance
Angina
Noctural cough
Orthopnoea 
Dyspnoea 
Displaced apex
Pulmonary oedema
Weight loss

Question 16

Signs of CHF

Answer 16

Narrow pulse pressure

Question 17

What could cause thrills?

Answer 17

Pulmonary

aortic valve failure

Question 18

What would be causing a heave?

Answer 18

RHF so heart is throbbing against

Question 19

What do you call enlargement of the heart

Answer 19

Cardiomegaly

Question 20

What do you call both RHF and LHF together?

Answer 20

Congestive heart failure

Question 21

Investigations

Answer 21

BP
CXR
Trans thoracic echo (gold standard)

Question 22

Investigations

Answer 22

BP
CXR
ECG
U and E

Trans thoracic echo (gold standard)
BNF

Question 23

What are the five signs of HF on a CXR (ABCDE)

Answer 23

A - alveolar oedema 
B - curly B lines
C - cardiomegaly 
D - dilated upper lobe
E - pleural effusion

Question 24

What are the five signs of HF on a CXR (ABCDE)

Answer 24

A - alveolar oedema 
B - curly B lines
C - cardiomegaly 
D - dilated upper lobe
E - pleural effusion (hazy lines)

Question 25

Where is BNP released from?

Answer 25

Atria, released during heart strain

Question 26

Drugs prescribed?

Answer 26

Frusemide

Question 27

What kind of diuretic is frusemide?

Answer 27

Loop diuretic

Question 28

What lifestyle modifications would you advise for someone with HF?

Answer 28

Cut smoking Lose weight Diabetes management

Question 29

What drugs would these patients have to avoid?

Answer 29

NSAIDS Negative inotropes Flu and pneumoccoal vaccinces

Question 30

Drugs for HF

Answer 30

``` ACEi Beta blockers Mineralocorticoid receptor antagonists Digoxin Vasolidators e.g. GTN and hydralazine ```

Question 31

Which of these actually improve mortality?

Answer 31

Mineralocorticoid receptor antagonist

Question 32

Example of mineralocorticoid receptor antagonist

Answer 32

Spironolactone

Question 33

What you should be careful about with hydralazine?

Answer 33

Renal failure

Question 34

Other options?

Answer 34

Transplant (but v risky with HF patients) | palliation

Question 35

How do you manage chronic diseases, in order?

Answer 35

CONSERVATIVE MEDICAL SURGICAL

Question 36

How do you treat an acute disease?

Answer 36

``` ABCDE approach Airway Breathing Circulation Disability Exposure ```

Question 37

How do you open someone's airway?

Answer 37

Head tilt | Chin lift

Question 38

When do you do a jaw thrust?

Answer 38

if they have a cervical spine trauma

Question 39

What would you do with breathing looking for?

Answer 39

Pulse oximeter | ABGs

Question 40

When do you give oxygen?

Answer 40

If sats are lower than 96%, give 15l of oxygen in a non rebreathe mask

Question 41

What do you do if you've had to intervene at some point during ABCDE?

Answer 41

Always recheck from A to E again if you intervened, e.g. if you gave oxygen at some point

Question 42

What would you do for circulation

Answer 42

``` Blood pressure Pulse Active bleeding Cyanosis Warm peripheries Heart monitor (3/12 lead ECG) Cannulate ```

Question 43

If someone doesn't have a radial pulse, what do you know?

Answer 43

That the bp is above 80mmHg

Question 44

What does the D stand for?

Answer 44

Disability also: DEFG Don't ever forget glucose

Question 45

Mnemonic for GCS scoring?

Answer 45

AV PU (have a poo) Alert (ask pt to squeeze hand) Voice Pain Unresponsive

Question 46

How do you check whether someone is alert?

Answer 46

Push down on nails | Push down above eyes

Question 47

What does E stand for?

Answer 47

exposure

Question 48

What do you do when looking for exposure?

Answer 48

``` Trauma Stab wounds Rash (meningitis) Oedema Pulsation ```

Question 49

Acute management of HF

Answer 49

``` Sit patient upright Give high flow oxygen IV access ECG Morphine Furesmide GTN spray if blood pressure is above 90 Assess reversible causes ```

Question 50

Complications of HF

Answer 50

``` Reduced lung function Chronic anaemia Impaired kidney disease (due to HTN) Syncope Wheeze and cough Cachexia MI ```