heart failure

Question 1

what is the definition of heart failure ?

Answer 1

heart failure is the inability of the heart to maintain its demand

Question 2

generally what is the cause of heart failure ?

Answer 2

any functional or structural impairment of blood ejection or ventricular filling

Question 3

what is the most common cause of heart failure?

Answer 3

coronary artery disease

Question 4

how is the cardiac output calculated ?

Answer 4

stroke volume multiplied by heart rate

Question 5

what is stroke volume determined by ?

Answer 5

pre load
after load
myocardial contractility

Question 6

what physiological measure can be used the overall function of the heart ?

Answer 6

ejection fraction

Question 7

what is the ejection fraction ?

Answer 7

percentage of the blood within the chamber that is pumped out with every heartbeat

Question 8

what is the normal ejection fraction ?

Answer 8

55 to 75 percent

Question 9

what is the aetiology of heart failure ?

Answer 9

heart failure is a clinical consequence

valvular heart disease 
pericardial disease 
high output states 
volume overload 
congenital heart disease

Question 10

what is the pathophysiology of heart failure ?

Answer 10

an imbalance occurs in three neurohormonal systems :
the renin-aldosterone system
the sympathetic nervous system
the nariuteric peptide system

Question 11

what are the classifications of heart failure ?

Answer 11

systolic heart failure
diastolic heart failure
mixed systolic and diastolic heart failure

Question 12

what is the ejection fraction in each of the types of heart failure ?

Answer 12

systolic heart failure - ejection fraction is 40%
diastolic heart failure - ejection fraction is normal
mixed systolic and diastolic- ejection fraction is 35%

Question 13

when do we see mixed systolic and diastolic failure ?

Answer 13

dilated cardiomyopathy

Question 14

what are the typical symptoms of heart failure?

Answer 14

breathlessness 
orthopnea 
paroxysmal nocturnal dyspnoea 
reduced exercise tolerance 
ankle swelling

Question 15

what are the more specific signs of heart failure ?

Answer 15

elevated jugular venous pressure 
hepato-jugular reflex 
third heart sound ( gallop rhythm)
laterally displaced apical impulse 
cardiac murmur

Question 16

what are the signs of left sided heart failure ?

Answer 16

paroxysmal nocturnal dyspnea 
pulmonary congestion 
elevated pulmonary capillary wedge pressure 
cyanosis 
exertional dyspnea

Question 17

what are the signs of pulmonary congestion ?

Answer 17

cough 
crackles 
wheezes 
blood tinged sputum 
tachypnea

Question 18

what are the signs of right sided heart failure ?

Answer 18

venous congestion
cor pulmonale
distended jugular veins
hepatomegaly
splenomegaly
ascites
dependent edema
increased peripheral venous pressure
~~~

Question 19

how would you asses the aetiology of HF ?

Answer 19

angiography
cMRI
biopsy

Question 20

how would you confirm a diagnosis of HF?

Answer 20

natriuretic peptides
and echo

Echocardiography

Question 21

what are the steps following an acute onset with heart failure ?

Answer 21

perform ECG , chest x-ray
then echocardiography along with BNP and NT-pro BNP
then if the ECG turns out normal NT-pro BNP is below 300 or BNP is below 100 then heart failure is unlikely

Question 22

what results would make us suspect heart failure ?

Answer 22

if the ECG turned out abnormal
NT pro-BNP was equal to or more than 300
BNP was equal to or more than 100

Question 23

what to do when the lab results are leaning towards heart failure ?

Answer 23

perform an echocardiogram

Question 24

how do you treat heart failure ?

Answer 24

first with lifestyle changes 
to improve signs and symptoms:
diuretics 
Calcium channel blockers
management of underlying disease

Question 25

what kind of lifestyle changes can be made ?

Answer 25

salt restriction exercise cessation of alcohol and smoking decrease in body weight

Question 26

what is the drug management for congestive heart failure ?

Answer 26

ACE inhibiots Angiotensin II receptor blockers beta blockers loop diuretics furosemide

Question 27

why would anticoagulants be used in heart failure pateints?

Answer 27

thromboembolic problems may be caused because of stasis and stagnant blood flow

Question 28

what are the surgical interventions for congestive heart failure?

Answer 28

``` coronary artery bypass grafting (CABG) percutaneous coronary intervention valve replacement heart transplantation left ventricular assist device ```

Question 29

what type of pulse , rhythm and valvular disease is seen in left sided heart failure?

Answer 29

pulse: pulsus alternans rhythm : s3 gallop rhythm valvular HDd : mitral regurgitation

Question 30

how does the RAAS system hav a role in heart failure?

Answer 30

first it serves as a compensatory mechanism but later on it increases preload and after load

Question 31

what is the normal function of natriuretic peptides ?

Answer 31

they prevent cardiac. hypertrophy and remodelling

Question 32

what does preload and afterload mean ?

Answer 32

preload is the diastolic force afterload is the systolic force

Question 33

what is high output cardiac failure and what are the causes ?

Answer 33

thee ejection fraction is normal but the metabolic demands have increased and they have not been met anemia thyrotoxicosis sepsis pagets disease of the bones AV malformation

Question 34

what are the features of diastolic heart failure ?

Answer 34

pulmonary congestion pulmonary hypertension ventricular hypertrophy

Question 35

what are the changes seen on X ray of heart failure ?

Answer 35

A: alveolar oedema B: kerley B sign C: cardiomegaly D: upper lobe blood diversion E: pleural effusion F: fluid in horizontal fissure

Question 36

what is the initial management for a patient with pulmonary oedema ?

Answer 36

sit the patient up give oxygen therapy IV furosemide to reach diuresis IV nitrates GTN infusion if all failed CPAP

Question 37

what are the types of pulmonary oedema ?

Answer 37

cardiogenic - due to increased in pulmonary venous pressure noncardiogenic - increase in the capillary permeability

Question 38

when can we use inotropic therapies in pulmonary oedema ?

Answer 38

if there is signs of shock or hypoperfusion of other organs

Question 39

what type of congestion is associated with LVF and RVF ?

Answer 39

LVF is associated with pulmonary congestion RVF is associated with venous congestion

Question 40

what medications are used for HF with reduced EF ?

Answer 40

systolic HF or HFFrEF BASH Beta blockers ACE inhibitors Spironolactone Hydrasalazine

Question 41

what does s3 gallop rhythm indicate ?

Answer 41

volume overload usually owing to congestive heart failure

Question 42

what is heard on auscultation of patient with pulmonary oedema ?

Answer 42

bi basal crepitations