Left ventricular failure

Question 1

What is the definition of left ventricular failure?

Answer 1

Syndrome that results from any structural or functional cardiac disorder in the LV that impairs the ability of the heart to function as a pump

Question 2

What is the epidemiology of left ventricular failure?

Answer 2

5% of admissions to hospital medical wards

Question 3

What is the pathology of left ventricular failure?

Answer 3

• 2 types: systolic failure and diastolic failure
• Systolic: LV cannot contract normally so the heart cannot pump with enough force to push enough blood into circulation
• Diastolic: LV cannot relax normally due to stiffness so the heart cannot properly fill with blood during
• Categorised into Classes I-IV via the New York Heart Associations Classification of Heart Failure

Question 4

What are the risk factors/aetiology of left ventricular failure?

Answer 4

• ↑ age
• Ischemic heart disease
• Cardiomyopathy
• MI
• Myocarditis
• Coronary artery narrowing
• Hypertension
• Aortic stenosis/incompetence
• Mitral incompetence
• Congenital septal defects

Question 5

What are the signs/symptoms of left ventricular failure?

Answer 5

• Dyspnoea
• Poor exercise tolerance
• Fatigue
• Orthopnoea
• Paroxysmal nocturnal dyspnoea (sometimes with pink, frothy sputum)
• Wheeze
• Nocturia
• Cold peripheries
• Weight loss
• Muscle wasting
• Peripheral/central cyanosis
• Tachypnoea
• Tachycardic
• Hypotensive
• Narrow pulse pressure – difference between systolic and diastolic pressure readings
• Pulsus alternans – pulse showing alternate strong and weak beats
• Aortic/mirtal valve murmurs
• Displaced apex beat

Question 6

What investigations are carried out in suspected left ventricular failure?

Answer 6

• ECG
• Doppler echocardiography
• BNP/NTproBNP serum levels
• Bloods: FBC, U&E, creatinine, LFTs, glucose, fasting lipids, TFTs, cardiac enzymes
• CXR – cardiomegaly, ventricular hypertrophy, ‘bat wings’, pleural effusion, kerley B lines
• Cardiac MRI – gold standard
• Urinalysis
• Lung function tests

Question 7

What are the pharmacological treatments for left ventricular failure?

Answer 7

• Oxygen
• ACE inhibitor
• Diuretic
• Beta blocker
• Digoxin
• Vasodilators
• Opiate analgesia
• GTN

Question 8

What are the non pharmacological treatments for left ventricular failure?

Answer 8

• Sit patient up
• Smoking cessation
• Low salt diet
• Weight management
• Healthy diet