Heart Failure

Question 1

What is heart failure?

Answer 1

When the heart cannot deliver adequate cardiac output to meet the metabolic needs of the body

Question 2

What might the symptoms of heart failure be manifested by?

Answer 2

Symptoms of poor perfusion, and/or symptoms of congestion of circulation

Question 3

What follows compromise of cardiac stroke volume in heart failure?

Answer 3

Cardiac decompensation and heart failure

Question 4

What are the underlying pathophysiological mechanisms that lead to compromise of cardiac stroke volume, cardiac decompensation, and heart failure?

Answer 4

• Increased afterload (pressure work)
• Increased preload (volume work)
• Myocardial abnormalities
• Tachycardias

Question 5

What is heart failure usually due to in neonates?

Answer 5

Obstructed systemic circulation

Question 6

What are the causes of obstructed systemic circulation in neonates?

Answer 6

• Hypoplastic left heart syndrome
• Critical aortic valve stenosis
• Severe coarction of the aorta
• Interruption of the aortic arch

Question 7

What is heart failure usually due to in infants?

Answer 7

High pulmonary blood flow

Question 8

What can cause high pulmonary blood flow in infants?

Answer 8

• Ventricular septal defects
• Atrioventricular septal defects
• Large persistent ductus arteriosus

Question 9

What are the causes of heart failure in older children and adolescents?

Answer 9

• Eisenmenger syndrome
• Rheumatic heart disease
• Cardiomyopathy

Question 10

What are the clinical features of heart failure?

Answer 10

• Breathlessness, particularly on feeding and exertion
• Sweating
• Poor feeding
• Recurrent chest infections
• Poor weight gain or faltering growth
• Tachypnoea
• Tachycardia
• Heart murmur/gallop rhythm
• Enlarged heart
• Hepatomegaly
• Cool peripheries

Question 11

What investigations should be done in heart failure?

Answer 11

• CXR
• Echo
• ABG
• ECG
• Serum electrolytes

Question 12

What may be found on CXR in heart failure?

Answer 12

Cardiac enlargement and oligaemic lungs with pleural effusions

Question 13

What may be found on echo in heart failure?

Answer 13

Congenital heart defects

Question 14

What may be found on ABG in heart failure?

Answer 14

Reduced pO2 or metabolic acidosis

Question 15

Why should ECG be done in heart failure?

Answer 15

May help determine aetiology

Question 16

What may be found on serum electrolytes in heart failure?

Answer 16

Hyponatraemia due to water retention

Question 17

What is the definitive management for heart failure?

Answer 17

Management of the underlying cause

Question 18

What general measures are involved in the management of heart failure?

Answer 18

• Bed rest, and nurse in semi-upright position
• Supplemental oxygen
• Diuretics
• ACE inhibitors
• Sufficient calorie intake