Investigation of Acute Heart Failure
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Questions and Answers

Which of the following conditions can cause heart failure?

  • Cardiomyopathies
  • Drugs
  • Toxins
  • Endocrine conditions
  • All of the above (correct)
  • What is the recommended maximum daily dose of sodium nitroprusside for people with acute heart failure without incremental improvement in diuresis?

  • There is no maximum dose (correct)
  • 25mg OD
  • 10mg OD
  • 50mg OD
  • In a person presenting with acute heart failure who is already taking beta-blockers, continue the beta-blocker treatment unless they have a heart rate less than 50 beats per minute, second or third degree atrioventricular block, or shock. When should you start or restart beta blocker treatment during hospital admission in people with acute heart failure due to left ventricular systolic dysfunction, once their condition has been stabilised?

  • When the patient has been discharged from the hospital
  • Immediately
  • For a maximum of 25-50mg BD
  • When intravenous diuretics are no longer needed (correct)
  • Offer an angiotensin-converting enzyme inhibitor (angiotensin receptor blocker if intolerant) and an aldosterone antagonist during hospital admission if the left ventricular ejection fraction is not tolerated.

    <p>False</p> Signup and view all the answers

    What is the recommended maximum daily dose of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker ?

    <p>10mg OD</p> Signup and view all the answers

    Ensure that the person's condition is stable for typically 48 hours after starting or restarting beta blockers and before discharging from the hospital.

    <p>True</p> Signup and view all the answers

    Check daily weight, BP and pulse every 6hrs and repeat chest x-ray.

    <p>True</p> Signup and view all the answers

    Convert diuretic dose to oral dose and stabilise.

    <p>True</p> Signup and view all the answers

    A follow-up clinical assessment should be undertaken by a member of the specialist heart failure team within 2 weeks of the person being discharged from hospital.

    <p>True</p> Signup and view all the answers

    Refer patients with suspected heart failure and previous myocardial infarction (MI) urgently, to have transthoracic Doppler 2D echocardiography and specialist assessment within 2 weeks. What is the other investigation recommended?

    <p>All of the above</p> Signup and view all the answers

    Which of the following are standard investigations for people presenting with new suspected acute heart failure?

    <p>All of the above</p> Signup and view all the answers

    Which of the following is a standard blood test for suspected acute heart failure?

    <p>All of the above</p> Signup and view all the answers

    In people presenting with new suspected acute heart failure, use a single measurement of serum natriuretic peptides (B-type natriuretic peptide or N-terminal pro-B-type natriuretic peptide) and the following thresholds to rule out the diagnosis of heart failure.

    <p>True</p> Signup and view all the answers

    Which of the following is a natriuretic peptide threshold used to rule out heart failure?

    <p>Both A and B</p> Signup and view all the answers

    In people presenting with new suspected acute heart failure with raised natriuretic peptide levels, perform transthoracic Doppler 2D echocardiography to establish the presence or absence of cardiac abnormalities.

    <p>True</p> Signup and view all the answers

    In people presenting with new suspected acute heart failure, consider performing transthoracic Doppler 2D echocardiography within 48 hours of admission to guide early specialist management.

    <p>True</p> Signup and view all the answers

    Do not routinely offer pulmonary artery catheterisation to people with acute heart failure.

    <p>True</p> Signup and view all the answers

    What is the initial treatment for people with suspected acute heart failure?

    <p>Both A and B</p> Signup and view all the answers

    Administer oxygen before investigation.

    <p>True</p> Signup and view all the answers

    Study Notes

    Investigations

    • Take a history, perform a clinical examination and undertake standard investigations to rule out other causes.
    • ECG (Signs of MI, dysrhythmias)
    • Chest X-ray (look for cardiomegaly, signs of pulmonary oedema)
    • Blood tests (electrolytes, urea and creatinine, eGFR, thyroid function tests, fasting lipids, fasting glucose, full blood count)
    • Urinalysis
    • Arterial blood gases
    • Peak flow or spirometry

    Measurement of serum natriuretic peptide levels

    • In people presenting with new suspected acute heart failure, use a single measurement of serum natriuretic peptides (B-type natriuretic peptide or N-terminal pro-B-type natriuretic peptide) and the following thresholds to rule out the diagnosis of heart failure:
      • B-type natriuretic peptide less than 100 ng/litre
      • N-terminal pro-B-type natriuretic peptide less than 300 ng/litre.

    Echocardiography

    • In people presenting with new suspected acute heart failure with raised natriuretic peptide levels, perform transthoracic Doppler 2D echocardiography to establish the presence or absence of cardiac abnormalities.

    • In people presenting with new suspected acute heart failure, consider performing transthoracic Doppler 2D echocardiography within 48 hours of admission to guide early specialist management.

    • Do not routinely offer pulmonary artery catheterisation to people with acute heart failure.

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    Description

    This quiz covers the essential investigations involved in diagnosing acute heart failure, including clinical examinations, ECG, blood tests, and notables like serum natriuretic peptides. Test your knowledge on how different tests help rule out other causes and confirm heart failure diagnoses. Ideal for medical students and professionals keen on cardiology.

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