Cardiology- Heart failure

Question 1

What are the 8 known causes of heart failure?

Answer 1

• Ischaemic heart disease
• Hypertension
• Valvular heart disease
• Atrial fibrillation
• Chronic lung disease
• Cardiomyopathy
• Previous cancer chemo drugs
• HIV

Question 2

What is HFREF?

Answer 2

Heart failure reduced ejection fraction.

Systolic heart failure, around 50% of cases

Question 3

What is HFNEF?

Answer 3

Heart failure normal ejection fraction.

ECGs show mild impairment or normal systolic function

Question 4

What factors contribute to a patient having HFNEF?

Answer 4

Elderly
Overweight
Hypertension
Atrial Fibrillation

Question 5

What is the physiology behind HFNEF?

Answer 5

Impaired filling or diastolyic dysfunction

Question 6

What is the mortality rate after heart failure diagnosis?

Answer 6

10% as inpatient

50% in the following 12 months after discharge

Question 7

What 6 factors worsen the prognosis after heart failure?

Answer 7

Fluid overload
High NT-proBNP levels
Renal impairment
Advanced age
Multi-morbidity
Frequent heart failure admissions

Question 8

What 6 things can be tested in bloods for heart failure investigation?

Answer 8

• Renal function
• FBC
• LFTs hepatic congestion
• TFTs thyroid disease
• Ferritin and transferrin
• Brain natriuretic peptid (NT-proBNP)

Question 9

Why doesn’t elevated NTproBNP definitely mean heart failure?

Answer 9

Any event which causes increased cardiac stress can elevate this peptide.
eg. atrial fibrillation or RV strain

Question 10

How is LV function assessed?

Answer 10

ECG

Cardiac MRI

Question 11

What 4 lifestyle modifications are put in place to reduce risk of heart failure?

Answer 11

• Smoking cessation
• Restriction of alcohol consumption
• Salt restriction
• Fluid restriction

Question 12

What is the most effective symptomatic treatment for heart failure?

Answer 12

Loop diuretics
-Furosemide
-Bumetanide
-Bendroflumethiazide
=Metolozone

Question 13

What treatment is especially useful for a patient who is hypertensive?

Answer 13

Angiotensin converting enzyme inhibitors (ACEIS)

Question 14

What are valsartan and candesartan examples of?

Answer 14

Angiotensin 2 receptor antagonists

Question 15

What are angiotensin receptor-neprilysin inhibitors recommended for?

Answer 15

Treatment of chronic heart failure with reduced ejection fraction
Only for people with NYHA class II to IV symptoms with LV ejection fraction less than 35%
Already on a stable dose of ACEIs or ARBs

Question 16

Give 3 examples of beta-blockers

Answer 16

6-blockers
Carvedilol
Bisoprolol

Question 17

What factors determine if it is safe to initiate usage of 6-blockers?

Answer 17

Systolic BP >100mmHg
Resting heart rate >60bpm
No significant postural drop

Question 18

What drugs are generally used if people cannot take ACEI or ARBs?

Answer 18

Vasodilators such as hydralazine and isosobide mononitrate

Question 19

What drug is used for those who cannot tolerate 6-blockers?

Answer 19

Ivabradine

Question 20

Why is ivabradine useful for those with low BP?

Answer 20

Has no effect on blood pressure

Question 21

What 3 things do nitrates reduce?

Answer 21

Preload
Pulmonary oedema
Ventricular size

Question 22

What can nitrates relieve in chronic heart failure?

Answer 22

Orthopnoea and exertional dyspnoea

Question 23

What is evident on ECGs to warrant fitting of a pacemaker?

Answer 23

Left bundle branch block
-QRS duration is broad. Depolarisation of electricity from septum to lateral wall is delayed leading to mechanical reduction

Question 24

What type of pacemaker is fit to reduce the duration of the QRS phase?

Answer 24

Cardiac resynchronisation pacemaker (CRT_

Question 25

What device is fit to prevent sudden cardiac death associated with heart failure?

Answer 25

Implantable cardiac defibrillator (ICD)

-deliver electric shock