Cardiac Failure

Question 1

What is cardiac failure?

Answer 1

Where cardiac output does not meet the demands of the body at normal filling pressures

Question 2

What is systolic cardiac failure? What are the main causes?

Answer 2

• CF due to reduced ejection fraction
• IHD, dilated cardiomyopathy

Question 3

What is diastolic cardiac failure? What are the main causes?

Answer 3

• CF due to increased filling pressures. Ejection fraction preserved
• Hypertrophy, hypertensive heart disease, valvular disease, restrictive cardiomyopathy

Question 4

What can be the causes of normal function cardiac failure?

Answer 4

Anaemia, thyrotoxicosis, sepsis, tachycardia

Question 5

Outline the pathophysiology of cardiac failure

Answer 5

• Cardiac output is decreased (systolic/diastolic)
• Preservation is attempted
  
  • RAAS activation (salt, water retention)
• Ventricular EDP increases
  
  • Oedema results

Question 6

What signs/symptoms on presentation are specific for cardiac failure? What others might be present?

Answer 6

• Orthopnoea, peripheral oedema (with JVP raise)
• S3 (rapid ventricular filling), murmurs, creps, cyanosis

Question 7

Outline the investigative work-up for suspected cardiac failure

Answer 7

• FBE (anaemia?)
• ECG
• CXR (heart size, effusions)
• Echocardiogram (systolic vs. diastolic)
• BNP levels - raised in heart failure

Question 8

What are the principles of management of systolic heart failure?

Answer 8

• Alleviate symptoms
  
  • Beta blockers (bisoprolol), diuretics
  • Ivabradine (if sinus rhythm and BB intolerance)
  • Digoxin (if AF)
  • Surgery (pacemaker/defib)
• Delay disease progression
  
  • ACEIs (perindo/ramipril)
• Reduce mortality
  
  • Lifestyle changes
• Treat underlying cause