Heart failure and its management

Question 1

What are the affects of heart failure

Answer 1

Afterload goes up, contractility and heart rate goes up, high pressure in venous system, leakage of fluid from capillaries

Question 2

Which vessels will leak in left/right sided heart failure

Answer 2

Left- veins coming from lungs

Right- veins coming from rest of the body

Question 3

What are mechanisms such as vasoconstriction and fluid retention designed to do

Answer 3

Restore blood pressure

Question 4

What other systems are activated to restore blood pressure

Answer 4

• Anti-diuretic hormone
• Natriuretic peptides
• Atrial stretch

Question 5

What is congestive heart failure

Answer 5

when the heart muscle is overworked due to stress, high blood pressure, arteriosclerosis, and fluids begin to collect in the body tissues, esp the lungs

Question 6

What is meant by chronic backward failure

Answer 6

Not all the blood is pumped out of the ventricle, can result in fluid retention and high venous pressures

Question 7

What do we characteristically see in left sided heart failure

Answer 7

Congestion of the pulmonary venous circulation, resulting in oedema formation in the interstitial fluid of the lungs and ultimately the alveoli of the lungs

Question 8

What do we characteristically see in right sided heart failure

Answer 8

Congestion of the systemic venous circulation. Fluid leaks into body cavities, have a very distended jugular vein

Question 9

What are typical presentation from a patient with left sided heart failure

Answer 9

• Coughing, fluid on lungs
• collapse
• heart disease in some cases
• non specific weight loss

Question 10

Describe stage A of heart failure

Answer 10

Patients at high risk of developing heart failure. No identifiable structural disorder of the heart

Question 11

Describe stage B1 and B2 heart failure patients

Answer 11

B1= asymptomatic patients, patients with no radiographic/ echocardiographic evidence of cardiac remodelling
B2= Asymptomatic patients with radiographic or echocardiographic evidence of left sided heart failure

Question 12

Describe stage C heart failure patients

Answer 12

Patients with past or current clinical signs of heart failure associated with structural heart disease

Question 13

Describe stage D heart failure patients

Answer 13

patients with end-stage disease, clinical signs of heart failure

Question 14

What are the main outcomes from cardiomyopathy

Answer 14

• Cardiac muscle fails
• Stroke volume fails
• Cardiac output fails

Question 15

Which group of drugs help the heart relax

Answer 15

Positive lusitropes (calcium channel blockers, beta blockers)

Question 16

What things should an owner consider in stage B1 heart failure

Answer 16

• weight control
• regular re-assessment
• client education

Question 17

What treatment should you consider for a patient in stage B2 heart failure

Answer 17

• Pimobendan
• weight control
• regular re-assessment
• client education

Question 18

What is traditionally used to remove diuretics

Answer 18

• loop diruretics= furosemide, torasemide

- Aldosterone antagonists= spirononlactone

Question 19

What can venodilators and arterial dilators do to help with vasodilation

Answer 19

Venodilators= increase venouse capacity, decrease preload, reduce fluid build up
Arterial dilators= reduce afterload, increase output, reduce valve leakage

Question 20

What is the effect of ACE inhibitors in tackling heart failure

Answer 20

• reduce level of angiotensin II
• this causes vasodilation
• reduces pre-load
• reduces systemic congestion

Question 21

How are dysrhythmias treated in a patient with heart failure

Answer 21

Require characterisation with ECG- antidysrhythmic drugs, beta blockers, calcium channel blocker, digoxin

Question 22

What are some adverse affects to therapy in treating heart failure/ dysrhythmias

Answer 22

• dose too high= lean weight/ fluid presence
• complecating factors e.g. renal dysfunction
• co-existing disease e.g. liver dysfunction
• effect of combinations of drugs
• will never be cured, only treating symptoms