Heart failure

Question 1

What is heart failure?

Answer 1

Cardiac output is insufficient for the body’s metabolic requirements

Question 2

What is the difference between systolic and diastolic HF?

Answer 2

Systolic (rEF): Ventricles can’t contract normally, giving decreased CO with reduced ejection fraction (<50%)
Caused by MI, IHD, cardiomyopathy

Diastolic (pEF): Ventricles can’t relax properly in diastole and can’t fill normally, giving increased filling pressures. Ejection fraction > 50%
Caused by ventricular hypertrophy, restrictive cardiomyopathy, obesity

Question 3

What are symptoms of (chronic) HF?

Answer 3

With left heart failure,

* Dyspnoea
* Poor exercise tolerance 
* Fatigue
* Orthopnoea 
* PND
* Nocturnal cough with pink frothy sputum 
* Cold peripheries 

With right heart failure,

* Peripheral oedema
* Ascites 
* Facial engorgement
* Pulmonary oedema (crackles)

Question 4

What are signs of HF?

Answer 4

• Cyanosis 
	• Low BP
	• Narrow pulse pressure
	• Displaced apex beat 
RV heave (pulmonary hypertension)

Question 5

What investigations would you do for suspected HF?

Answer 5

Bloods: including Hb for anaemia and BNP and troponin

CXR

ECG: can indicate possible cause

Echo: shows LV dysfunction

Question 6

What is management of chronic HF?

Answer 6

Treat the cause

Diuretics

ACEi or ARB

Beta blocker

Spironolactone

salcubitril/valsartan (stop ACEi)

Digoxin

ICD/CRT-D

LVAD or transplant

Question 7

What is management of acute HF?

Answer 7

• Sit patient upright
	• High flow oxygen if sats are low
	• IV access and monitor ECG
	• Treat any arrhythmias 
	• Give
		○ Diamorphine 
		○ Furosemide
		○ GTN spray (not if SBP <90)

If SBP >100, nitrate infusion

If patient SBP < 100, treat as cardiogenic shock

Question 8

What is cor pulmonale?

Answer 8

R hart failure occuring as result of L heart failure