20. Heart Failure Investigations And Management

Question 1

What are the heart failure NYHA functional classes?

Answer 1

Class 1 - no symptomatic limitation of physical activity
Class 2 - slight limitation of physical activity, no symptoms at rest
Class 3 - marked limitation of physical activity, no symptoms at rest
Class 4 -inability to carry out any physical activity without symptoms, may have symptoms at rest

Question 2

What are the key questions for investigations?

Answer 2

Does the patient have heart failure? - history and clinical exam
What sort of heart failure does the patient have?
What is causing heart failure? - ischaemic heart disease, hypertension, viral

Question 3

What are the types of heart failure?

Answer 3

Left ventricular systolic dysfunction
Heart failure with a preserved ejection fraction
Valvular/structural heart failure
Right ventricular failure
High output cardiac failure

Question 4

What is the symptomatic treatment for heart failure?

Answer 4

Furosemide

Question 5

What is the prognostic treatment for LVSD?

Answer 5

Cardiac rehabilitation
ACE/ARB
Beta blocker
MRA (spironolactone)
Sacubitril valsartan 
ICD/biventricular pacemaker

Question 6

What blood tests are required in heart failure?

Answer 6

FBC - anaemia?
U&Es - renal function deteriorates
LFTs- hepatic congestion
Clotting
Thyroid function, vit D, CRP
NTpro-BNP

Question 7

What is NTpro-BNP?

Answer 7

Hormone released in response to atrial/ventricular stretch due to fluid overload

Question 8

What are the physiological effects of beta blockers?

Answer 8

Reduce heart rate
Reduce BP
Therefore reduced myocardial oxygen demand
Reduce mobilisation of glycogen
Negate unwanted effects of catecholamines

Question 9

How should you prescribe beta blockers?

Answer 9

With care
Initiate at low dose
Titrations slowly
May need to alter concomitant medication e.g. diuretic