Cardiology - Chronic Heart Failure

Question 1

What is the ejection fraction?

Answer 1

Percentage of blood pumped out of the left ventricle during systole

Ejection fraction above 50% is normal

Question 2

What is HFrEF?

Answer 2

Reduced ejection fraction

Less than 50%

Question 3

What is HFpEF?

Answer 3

Preserved ejection fraction

Clinical features of heart failure but ejection fraction is greater than 50%

Due to diastolic dysfunction, issue with left ventricle filling with blood during diastole

Question 4

What are the causes of chronic heart failure?

Answer 4

Ischaemic heart disease
Valvular heart disease
Hypertension
Arrhythmias
Cardiomyopathy

Question 5

What are the symptoms of chronic heart failure?

Answer 5

Breathlessness
Cough
Orthopnoea
Paroxysmal nocturnal dyspnoea
Peripheral oedema
Fatigue

Question 6

What signs on examination are there with chronic heart failure?

Answer 6

Tachycardia
Tachypnoea
Hypertension
Murmurs
3rd heart sound
Bilateral basal crackles
Raised JVP
Peripheral oedema

Question 7

What is paroxysmal nocturnal dyspnoea?

Answer 7

Patient suddenly wakes with severe attack of shortness of breath, cough and wheeze

Patient will sit on the bed or walk around the room

Question 8

What causes paroxysmal nocturnal dyspnoea?

Answer 8

• Fluid settles across a large surface area of the lungs as they life flat to sleep, as they stand it goes to bases
• During sleep respiratory centre less responsive, respiratory rate and effort don’t match reduced oxygen saturation
• Less adrenaline circulating while asleep, myocardium more relaxed reducing CO

Question 9

What is the New York Heart Association classification system used for?

Answer 9

Grade severity of symptoms related to heart failure

Class I- No limitation on activity
Class II- Comfortable at rest, symptomatic with ordinary actitives
Class III- Comfortable at rest, symptomatic with any activity
Class IV- Symptomatic at rest

Question 10

How quickly should patients be seen depending on NT-proBNP levels?

Answer 10

400-2000 ng/litre
Seen and echocardiogram within 6 weeks

Above 2000 ng/litre
Seen and echocardiogram within 2 weeks

Question 11

What conservative management is there for chronic heart failure?

Answer 11

Stop smoking
Optimise treatment of co-morbidities
Flu, covid and pneumococcal vaccines
Cardiac rehabilitation

Question 12

What medical treatments are used for chronic heart failure?

Answer 12

• ACEi
• Beta blocker
• Aldosterone antagonist (spironolactone or eplerenone)
• Loop diuretics

Question 13

What surgical options are available for chronic heart failure?

Answer 13

• Valvular heart repair procedures
• ICDs
• Cardiac resynchronisation therapy
• Heart transplant in severe disease

Question 14

What is cardiac resynchronisation therapy?

Answer 14

Used in severe heart failure with ejection fraction less than 35%

Biventricular (triple chamber) pacemakers

Leads in RA,RV and LV, synchronises contractions to optimise heart function