Podcast
Questions and Answers
Which of the following conditions can cause heart failure?
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?
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?
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.
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.
What is the recommended maximum daily dose of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker ?
What is the recommended maximum daily dose of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker ?
Ensure that the person's condition is stable for typically 48 hours after starting or restarting beta blockers and before discharging from the hospital.
Ensure that the person's condition is stable for typically 48 hours after starting or restarting beta blockers and before discharging from the hospital.
Check daily weight, BP and pulse every 6hrs and repeat chest x-ray.
Check daily weight, BP and pulse every 6hrs and repeat chest x-ray.
Convert diuretic dose to oral dose and stabilise.
Convert diuretic dose to oral dose and stabilise.
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.
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.
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?
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?
Which of the following are standard investigations for people presenting with new suspected acute heart failure?
Which of the following are standard investigations for people presenting with new suspected acute heart failure?
Which of the following is a standard blood test for suspected acute heart failure?
Which of the following is a standard blood test for suspected acute heart failure?
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.
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.
Which of the following is a natriuretic peptide threshold used to rule out heart failure?
Which of the following is a natriuretic peptide threshold used to rule out heart failure?
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 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.
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.
Do not routinely offer pulmonary artery catheterisation to people with acute heart failure.
What is the initial treatment for people with suspected acute heart failure?
What is the initial treatment for people with suspected acute heart failure?
Administer oxygen before investigation.
Administer oxygen before investigation.
Flashcards
NYHA Classification
NYHA Classification
A classification system for heart failure based on the patient's symptoms and limitations of physical activity.
Orthopnea
Orthopnea
Shortness of breath when lying down.
Paroxysmal nocturnal dyspnea
Paroxysmal nocturnal dyspnea
Sudden shortness of breath that wakes a patient up from sleep.
Nocturnal cough
Nocturnal cough
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Nocturia
Nocturia
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Acute Heart Failure
Acute Heart Failure
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JVP
JVP
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Pulmonary Edema
Pulmonary Edema
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Transthoracic Doppler 2D Echocardiography
Transthoracic Doppler 2D Echocardiography
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Blood tests for Heart failure
Blood tests for Heart failure
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High Natriuretic Peptides
High Natriuretic Peptides
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ACE Inhibitors
ACE Inhibitors
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Beta-Blockers
Beta-Blockers
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Diuretics
Diuretics
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Calcium Channel Blockers
Calcium Channel Blockers
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Anticoagulants
Anticoagulants
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Aspirin
Aspirin
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Inotropic Agents
Inotropic Agents
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Amiodarone
Amiodarone
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Ejection Fraction
Ejection Fraction
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Symptom Class
Symptom Class
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Cardiomyopathy
Cardiomyopathy
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Diastolic Heart Failure
Diastolic Heart Failure
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Systolic Heart Failure
Systolic Heart Failure
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Hypertrophic Cardiomyopathy
Hypertrophic Cardiomyopathy
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Aortic Stenosis
Aortic Stenosis
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Right Ventricular Failure
Right Ventricular Failure
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ARB
ARB
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Aldosterone Antagonist
Aldosterone Antagonist
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Coronary Artery Disease
Coronary Artery Disease
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Dilated Cardiomyopathy
Dilated Cardiomyopathy
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Edema
Edema
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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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