3.2.2 Heart Failure

Question 1

What is heart failure?

Answer 1

Inability or the heart to maintain adequate CO despite adequate filling pressure

Question 2

What are the symptoms of heart failure?

Answer 2

Dyspnoea
Fatigue
Oedema
Exercise intolerance

Question 3

What causes heart failure?

Answer 3

Ischaemic heart disease
Hypertension
Vascular disease
Cardiomyopthaies

Question 4

What are the different types of heart failure?

Answer 4

HFrEF- reduced ejection fraction, contractility issue, heart unable to pump with enough inotropy, thin and fibrosed ventricles

HFpEF- preserved ejection fraction, filling problem (diastolic) leads to thickening of the ventricular walls

Question 5

How do you treat chronic heart failure?

Answer 5

Correct underlying cause
Non-pharmacological treatment- basically life style stuff, reduce salt intake etc..

Question 6

What are the aims of treating heart failure?

Answer 6

Reduce symptoms
Increase exercise tolerance
Adress arrhythmias, hyperlipidaemia and diabetes
Increase QoL and slow morbidity

Question 7

How can heart failure be treated pharmacologically?

Answer 7

ACEi-HFrEF, if cannot take ACEi give ARBs, spironolactone if symptoms persist
ARBs

Diuretics for congestive symptoms and fluid retention

Question 8

What is Sacubitril/Valsartan?

Answer 8

Neprilysin inhibitor

Inhibits natriuretic inactiving enzyme, potentiates effects of ANP/BNP causing natriuresis

Stops breakdown of bradykinin, vasodilation

Valsartan is an ARB

Question 9

What does special re-assessment involve?

Answer 9

Implanted difbrillator
Sacubitril /valsartan

Digoxin-may help in patients with AF, produced symptomatic benefit in patients with sinus rhythm, no mortaility benefit

Ivabradine- If current blocker, slows HR

Hydralazine/nitrate- balanced venodilation and arteriodilation, reduced preload and afterload, increases CO

Question 10

What is given in acute heart failure?

Answer 10

I.V nitrates
Sympathomimetic inotropes