Systolic Heart Failure

Question 1

Why can a previous flu be related to systolic heart failure?

Answer 1

Flu nay cause myocarditis - inflammation of the heart muscle
- inflammatory cardiomyopathy
- caused by infection, drugs, toxins, auto immune disorders
- viral causes include: adenovirus, parvovirus, HIV, rubella, Polio and CMV

Question 2

How could acute viral myocarditis present?

Answer 2

• asymptomatic
• dysrhythmia - sudden cardiac death
• acute heart failure
• chronic heart failure

Question 3

Other causes of heart failure

Answer 3

• alcohol
• coronary heart disease (most common)
• congenital heart disease
• drugs - anthracycline or chemo
• genetics
• hypertension
• thyroid disease
  -valvular disease

Question 4

Signs and symptoms of HF

Answer 4

• depression of chronic illness
• elevated JVP
• pulmonary oedema
• orthopnoea (breathless on lying flat)
• PND - waking up from breathless sleep
• reduced blood pressure
• hepatomegaly
• ascites
• fatigue
• peripheral odema

Question 5

What is the most common blood test indicating heart failure?

Answer 5

N terminal Pro Brain Natriuretic peptide (NT-ProBNP) - released in response to stretch of heart muscle in hypervolaemia
Common in HF

The Natriuretic peptides ire released to cause vasodilation and decrease in the RAAS system = reducing BP

Question 6

What may a chest X-ray show in HF ABBCDE

Answer 6

Alveolar/pulmonary oedema

• bats wings sign
• Kelley B lines

Cardiomegaly (big heart)
Dilated prominent upper lobe vessels
Pleural effusion

Question 7

What may an echocardiogram show in systolic +- diastolic dysfunction HF

Answer 7

• left ventricular dilation
• a low Left ventricular ejection fraction on an echo
  (LVEF % = SV / end diastolic volume of the LV)

Question 8

What drugs can be used for HF

Answer 8

• loop diuretics - furosemide (symptom treating)
• Thiazide diuretics - bendroflumethiazide (symptom treating)
• inotropic agent - increases contraction force of heart - dobutamine to improve cardiac output
• ACE inhibitors/ARBS - decrease BP and volume
• Betablockers - decrease overactive sympathetic tone
• aldosterone agonists - ONE, eplerenone, spironolactone

Question 9

What else can be used for HF?

Answer 9

Heart transplant and immunosuppressive drugs

Left ventricular assist device (LVAD) - thrombosis risk despite warfarin