Heart failure Q+A

Question 1

1. Why is it only his ankles swelling up at this stage and why does the swelling go away at night?

Answer 1

• Right ventricular heart failure

- Due to gravity- when the man lies down the oedema gets distributed more evenly

Question 2

2. Why might he be short of breath when lying flat?

Answer 2

• Due to gravity- when lying down the oedema is spread through the lungs instead of just at the base
• Poorer diffusion of oxygen into the lungs
• Hypoperfusion

Question 3

3. What is suggested by visible jugular pulsation in the neck and how might this relate to the swelling of Edwards ankles?

Answer 3

• Right ventricular heart failure
• Hypertrophy of heart (and increased pulmonary resistance caused by left sided heart failure) means increased pressure in RA and RV- less blood from the venous system will flow into the heart
• Increased hydrostatic pressure in the venous end
• Peripheral oedema

Question 4

4. Why might the apex beat be forceful and displaced to the left? What does this tell you about the heart and which chamber is most affected?

Answer 4

• Left ventricular hypertrophy results in right ventricular hypertrophy
  i. Displaced apex to the left

Question 5

5. What investigations could you request in order to find out the size of Edwards heart?

Answer 5

• Echocardiogram

- Cardiothoracic ratio (X-ray)

Question 6

6. Why is Edward breathless on exertion?

Answer 6

• CO reduced
• Hypoperfusion of peripheral tissue
• Chemoreceptors detect high CO2
• Increase breathing rate

Question 7

7. What is congestive heart failure?

Answer 7

• Biventricular heart failure

Question 8

8. If jugular pulsation not visible in neck?

Answer 8

• Left sided heart failure

Question 9

9. On auscultation of her heart there is a murmur, occurring in mid diastole. It is associated with a distinct sound just after the second heart beat (S2). What sort of murmur is this?

Answer 9

• S1- closing of mitral valve
• S2- closing of the aortic valve
• Distinct sound after S2= turbulence of blood trying to get through the stenosed mitral valve
• Therefore… mitral valve stenosis

Question 10

10. If rhythm is irregularly irregular

Answer 10

• Think AF- ectopic sites in the atria
  i. Wavy baseline
  ii. No clear P wave
  iii. Normal QRS

Question 11

11. Why is there crepitations at the lung bases?

Answer 11

• Pulmonary oedema

- Gravity

Question 12

12. What might you do to prevent these problems recurring (mitral)?

Answer 12

• Heart valve replacement

- Pacemaker