CVS - Heart Failure Management

Question 1

Give the classic signs and symptoms of chronic heart failure

Answer 1

• pulmonary congestion
• venous congestion
• dependent oedema
• dyspnoea
• lethargy
• orthopnoea

Question 2

How can we test for chronic heart failure from visible signs?

Answer 2

Prominent JVP and pitting oedema

Question 3

Describe the ‘vicious cycle of heart failure’

Answer 3

• decreased CO and SV leads to decreased renal perfusion, so kidneys think the body is losing blood
• kidneys increase sodium/water retention (via RAAS and vasopressin) and therefore blood volume, which increases preload and filling pressure
• this leads to ventricular dilatation and increased wall stress, which compounds CO/SV problems
• decreased renal perfusion also activates neurohormonal systems which cause an increase in systemic vascular resistance and outflow resistance, impairing the function of the left ventricle

Question 4

What are the two main classes of drug used to treat heart failure?

Answer 4

• beta-blockers, which target the sympathetic nervous system

- RAAS inhibitors (ACEI, ARB, MRA), which target the renin-angiotensin-aldosterone system

Question 5

How is a pacemaker lead inserted into the left ventricle?

Answer 5

Through coronary sinus into venous drainage of the left ventricle