Cardiology [Heart Failure]

Question 1

Define acute cardiac failure

Answer 1

A syndrome in characterised by rapidly worsening signs/symptoms associated with abnormality in cardiac structure and/or function

Question 2

What are the most common causes of acute cardiac failure? (9)

Answer 2

Coronary artery disease (Acute coronary syndrome)

Hypertension

Acute pulmonary embolism

Valular diseases

Cardiomyopathy

Myocarditis

Rapid arrythmias (e.g. atrial fibrilation)

Cardiac tamponade

Acute mechanical causes (e.g. acute mitral regurgitation, myocardial rupture)

Question 3

What are 2 examples of rare causes of acute cardiac failure?

Answer 3

Anaemia

Hyperthyroidism

Question 4

List risk factors for acute cardiac failure (10)

Answer 4

Cardiovascular disease

Coronary heart disease

Older age (>70)

Diabetes

Family history of ischaemic heart disease or cardiomyopathy

Alcohol

Smoking

Cardiac arrhythmias (e.g. tachyarrhythmia or bradyarrhythmia)

Systemic conditions (e.g. sarcoidosis and haemochromatosis, hyperthyroidism)

Previous chemotherapy

Question 5

List examples of medication which can exacerbate acute cardiac failure. (4)

Answer 5

NSAIDs

Steroids

Verapamil (calcium channel blocker)

Dilitiazem (calcium channel blocker)

Question 6

List 5 presenting symptoms of acute cardiac failure.

Answer 6

Breathlessness

Peripheral oedema (usually bilateral and pitting)

Reduced exercise performance

Fatigue

Cold extremities (poor peripheral perfusion)

Question 7

What are the main signs of acute cardiac failure upon physical exmaination? (6)

Answer 7

Cold extermities

Prolonged capillary refill time

Elevated jugular venous pressure (due to congestion)

Displaced apex beat

Gallop rythym

Dullness to percussion at lung bases (due to congestion)

Pulmonary crepitations (wet crackles)

Question 8

What are the main investigations and typical findings for a patient with acute cardiac failiure? (8)

Answer 8

ECG: (Arrhythmias, Ischaemic ST- and T-wave changes)

Echocardiography: can determine the type of HF based on ejection fraction.

BNP: elevated

Chest Xray: Pulmonary oedema, pleural effusion, pulmonary congestion, cardiomegaly

Troponin: Elevated (degree of elevation can determine prognosis)

FBC: May show aneamia

D-dimer: Indicated pulmonary embolism causes

Urea, electrolytes and creatinine: Should be baseline

LFT: May be elevated due to reduced CO and increased venous congestion

TFT: Hyper and hypo can in some cases cause AHF

Question 9

What is a normal ejection fraction value?

Answer 9

50-70%

Question 10

What are the three main types of heart failure based on ejection fraction values?

Answer 10

Heart failure with reduced ejection fraction (HFrEF) [< 40%]

Heart failure with preserved ejection fraction (HFpEF) [50-75%]

Heart failure with mildy reduced ejection fraction (HFmrEF) [41-49%]