Cardiology - Heart Failure: General

Question 1

Heart Failure: Epidemiology

Answer 1

• 2% of Australians, 10% in >65yrs and >50% in >85yrs old

* HFpEF in 30-50% of all HF (highest incidence in >75yrs, and higher in females)

Question 2

Heart Failure: Aetiology

Name 3 Modifiable Risk Factors

Answer 2

• Hypertension (contributes to 40% men, 60% women)
• CAD (contributes to 34% men, 13% women)
• Diabetes and hypertension (increase risk but aren’t causal)

Question 3

Heart Failure: Aetiology

Causes of HFrEF

Answer 3

• Coronary artery disease (IHD is present in >50% of new HF) Chronic pressure overload:
• Hypertension (present in >60% of new HF)
• Obstructive valvular disease

Chronic volume overload

• Regurgitant valvular disease
• L to R shunting and extracardiac shunts Chronic lung disease
• Cor pulmonale
• Pulmonary vascular disorders

Nonischaemic dilated cardiomyopathy

• Familial
• Infiltrative
• Toxic/drug induced
• Viral/systemic (myocarditis / HIV / thyroid / SLE)
• Chagas Disease

Question 4

Heart Failure: Aetiology

What are the drugs and toxins that can cause HFrEF

Answer 4

Drugs:doxorubicin / trastuzumab / cyclophosphamide

Toxins:alcohol / cocaine / meth / cobolt / lead

Question 5

Heart Failure: Aetiology

Causes of HFpEF

Answer 5

• Coronary artery disease

Chronic pressure overload

• Hypertension
• Obstructive valvular disease
• Aging Pathologic hypertrophy
• Primary: hypertrophic cardiomyopathy
• Secondary: hypertension

Restrictive cardiomyopathy

• Infiltrative (amyloidosis / sarcoidosis)
• Storage: haemochromatosis
• Fibrosis
• Endomyocardial disease

Question 6

Heart Failure: Aetiology

Name the high output states that can lead to heart failure

Answer 6

• Metabolic disorders: thyrotoxicosis
• Nutritional disorders: beriberi
• Chronic anaemia
• Excessive blood flow requiremetns (ie systemic arteriovenous shunting, such as fistula)

Question 7

Heart Failure: Prognosis

Answer 7

At time of diagnosis of symptomatic HF:

• 30-40% mortality at 1 year
• 60-70% mortality at 5 years
• NYHA Class IV mortality 30-70% annually
• NYHA Class II mortality 5-10% annually
• 1 year survival for heart transplant or LVAD for HF is 85-90%

Question 8

Heart Failure: Poor Prognostic Factors

Answer 8

• Low oxygen consumption (peak O2 consumption <14)
• High ratio of ventilation:CO2 production (VE/VCO2 >34)
• Increasing NYHA class
• Repeat hospitalisations
• Hyponatraemia
• Worsening kidney function
• Increasing diuretic doses
• Intolerant of ACEi or beta blocker
• Arrythmias causing ICD firings
• S3 gallop
• Elevated JVP

Question 9

NYHA Classification

Answer 9

NYHA Class I:No symptoms even with exercise

NYHA Class II:Slightly limited exercise capacity. Ordinary physical activity is hard. (“difficult to climb stairs”)

NYHA Class III:Severely limited exercise capacity, even slight exercise is hard. Asymptomatic at rest.

NYHA Class IV:Symptoms even at rest