Acute Heart Failure

Question 1

Define heart failure.

Answer 1

The heart fails to provide adequate blood flow to meet the body’s needs.
Chronic disease with intermittent decompensations (acute heart failure) and eventually terminal.
The term ‘congestive heart failure’ is ill-defined, but typically refers to heart failure with fluid overload, especially pulmonary oedema.
Prevelance 1/70

Question 2

How can left ventricular failure be divided up?

Answer 2

Heart failure with reduced ejection fraction (HFrEF)

Heart failure with preserved ejection fraction (HFpEF)

Question 3

Give an overview of HFrEF.

Answer 3

Left ventricular ejection (EF) <40% (normal EF is >50%, with 40-49% a mid-range grey area.
Also known as systolic heart failure or left ventricular systolic dysfunction (LVSD)

Question 4

What are possible causes of HFrEF?

Answer 4

IHD/MI commonest cause
Hypertension
Diabetes usually via IHD
Dilated cardiomyopathy
Valve disease
Arrythmias
Drugs or alcohol

Question 5

Give an overview of HFpEF.

Answer 5

Left ventricle relaxation failure leading to inadequate filling leading to reduced stroke volume despite normal ejection fraction (>50%).
Also known as diastolic heart failure.

Question 6

What are the causes of HFpEF?

Answer 6

Hypertension commonest cause
Diabetes
Constrictive pericarditis
Cardiac tamponade
Restrictive cardiomyopathy

Question 7

What are the causes of right ventricular failure?

Answer 7

Right ventricular systolic dysfunction due to-

• Cor pulmonalae- primary lung disease (COPD) leading to vasoconstriction in poorly ventilated lung tissue to correct reduced V/Q leading to pulmonary hypertension leading to right ventricular failure.
• Left ventricular failure leading to pulmonary hypertension leading to right ventricular failure.
• Pulmonary valve stenosis (rare)

Question 8

What is high output heart failure?

Answer 8

A normally functioning heart with increased needs.

Question 9

What are the causes of high output heart failure?

Answer 9

Anaemia
Pregnancy
Hyperthyroidism