Hello and welcome to the zero to finals podcast.

My name's Tom and in this episode I'm going to be talking to you about chronic heart failure.

If you want to follow along with written notes, you can follow along at zero to finals.com forward slash heart failure or in the cardiology section of the zero definals medicine book.

So let's get straight into it.

As the name would suggest, chronic heart failure is essentially the chronic version of acute

heart failure. It's caused by either impaired left ventricular contraction, which is systolic heart failure, or left

ventricular relaxation, which is diastolic heart failure. This impairment in left

ventricular function results in a chronic back pressure of blood trying to flow into and through

the left hand side of the heart. And the way I picture this is a bit like a bus stop where too many buses have turned up at the same

time, causing a queue of buses down the road and traffic behind them all backed up and clogging up the roads.

When blood can't flow through the left-hand side of the heart and out into the body, it backs up into the left atrium and then into the pulmonary veins and into the lungs.

So what's the presentation of somebody with a chronic heart failure?

Some of the key features that they might present with is breathlessness, particularly worse on exertion.

A cough, and they might produce a frothy white or pink sputum.

Something called orthopnia, and this is a sensation of shortness of breath that's worse on lying flat

and relieved by sitting upright or standing.

A way to test for this is to ask them how many pillows they use at night time when they're asleep.

Paroxysmal nocturnal dysknear, and we'll talk a little bit about that in a sec.

And peripheral edema, so they might complain of swollen ankles or swollen legs.

Let's talk a little bit about paroxysmal nocturnal dysknear.

This is a term used to describe the experience that a patient have of suddenly waking up at night

with a severe attack of acute shortness of breath and cough.

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