3.5 Heart Failure Management

Question 1

Describe functional mitral regurgitation

Answer 1

• Left atrium or left ventricle dilates
• Causes mitral valve not to be able to close properly
• Leads to regurguitation

Question 2

Clinical definition of heart failure

Answer 2

• Signs and/or symptoms caused by structural or functional cardiac abnormality

Combined with at least one of:

• Elevated natriuretic peptide levels
• Objective evidence of cardiogenic pulmonary or systemic congestion

Question 3

Describe the four stages of heart failure

Answer 3

Stage A: patient is at risk for heart failure, but has no current or prior symptoms/signs
Stage B: Patients without prior symptoms or signs but with one of: structural/functional/natriuretic peptide abnormality
Stage C: Heart failure
Stage D: Severe symptoms or signs of HF at rest; consider transplantation, circulatory support, or palliation

Question 4

Describe HFimpEF

Answer 4

Patients receive medication for heart failure, and their ejection fraction improves despite the fact that their heart is failing

Question 5

Describe acute treatment of heart failure

Answer 5

• IV frusemide (loop diuretic)
• Fluid restriction
• Monitoring fluid input/output
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Question 6

What are the four main classes of drugs used in acute heart failure (other than diuretics)?

Answer 6

• ARNI
• Beta Blocker
• Mineralocorticoid receptor antagonist
• SGLT2 inhibitor

Question 7

Why are patients often switched from loop diuretics (fruzemide) to SGLT2 inhibitors after discharge?

Answer 7

• Weaker diuretic effect
• Better quality of life

Question 8

What type of scan are patients booked for after HF (hint: it provides more information about tissues than an echo)

Answer 8

Cardiac MRI

Question 9

Goals for follow-up management in HF

Answer 9

• Nursing programmes/exercise program/psychological support
• Gradual increase of medicatino
• Monitoring for improvement
• Assess candidacy for device therapy

Question 10

List three classes of drugs that can cause heart failure

Answer 10

• Corticosteroids
• Tyrosine kinase inhibitors
• Chemotherapeutic drugs

Question 11

List factors that can make heart failure worse

Answer 11

• Dietary lapse
• Atrial fibrillation recurrence
• Hyperthyroidism
• Sepsis

Question 12

Cardiac complications of heart failure

Answer 12

• Atrial fibrillation
• Ventricular fibrillation/tachycardia
• Chamber enlargement
• Valvular disorders

Question 13

Complications of left sided heart failure

Answer 13

• Pulmonary oedema
• Pulmonary hypertension/RV failure
• Cachexia
• Fatigue

Question 14

Complications of right sided heart failure

Answer 14

• Ascites/abdominal distension
• Hepatomegaly/cirrhosis (if chronic)
• Peripheral oedema

Question 15

A patient presents with dyspnoea; what are our immediate differentials?

Answer 15

Resp: Asthma/COPD
Cardio: HFpEF/HFrEF
Other: Anaemia, deconditioning, overlap syndrome

Question 16

A patient present with dyspnioea; what are our less common conditions?

Answer 16

Resp: interstitial lung disease
Cardio: Arrhytmia, valvular pathology, congenital heart disease

Question 17

A patient presents with dyspnoea; what are our rare conditions?

Answer 17

• Pulmonary hypertension
• Ischaemic heart disease without chest pain

Question 18

Chronic breathlessness red flags for early specialist referral

Answer 18

• Dyspnoea in regular activities
• Haemoptysis
• Connective tissue disease
• Chest pain
• Syncope
• Peripheral oedema
• Palpitations with breathlessness

Question 19

Investgiations indicated by dyspnoea

Answer 19

• FBC
• CXR
• ECG
• Resp function test
• Echo

Question 20

Ejection systolic murmur; common diagnoses

Answer 20

Pulmonary/aortic stenosis

Question 21

Holosystolic murmur; diagnoses

Answer 21

• Mitral/tricuspid regurgitation
• Ventricular septal defect

Question 22

What can cause diastolic murmurs?

Answer 22

• Mitral/tricuspid stenosis
• Aortic/pulmonary regurgitation