Chronic Heart Failure

Question 1

What is Heart failure?

Answer 1

refers to the clinical features of impaired heart function, specifically the function of the left ventricle to pump blood out of the heart and around the body.

Impaired left ventricular function results in a chronic backlog of blood waiting to flow into and through the left side of the heart. The left atrium, pulmonary veins and lungs experience an increased volume and pressure of blood. They start to leak fluid and cannot reabsorb excess fluid from the surrounding tissues, resulting in pulmonary oedema.

Question 2

What is ejection fraction? And what happens to it in HF (what are the two types)?

Answer 2

percentage of blood in the left ventricle squeezed out with each ventricular contraction. An ejection fraction above 50% is considered normal.

HF with reduced ejection fraction is when the ejection fraction is less than 50%.

Heart failure with preserved ejection fraction is when someone has the clinical features of heart failure but an ejection fraction greater than 50%. This is the result of diastolic dysfunction, where there is an issue with the left ventricle filling with blood during diastole (the ventricle relaxing).

Question 3

What are the causes of HF?

Answer 3

• Ischaemic heart disease
• valvular heart disease (commonly aortic stenosis)
• hypertension
• arrhythmias (commonly AF)
• Cardiomyopathy

Question 4

What are the key presentations?

Answer 4

• Breathlessness, worsened by exertion
• Cough, which may produce frothy white/pink sputum
• Orthopnoea, which is breathlessness when lying flat, relieved by sitting or standing (ask how many pillows they use)
• Paroxysmal nocturnal dyspnoea (more detail below)
• Peripheral oedema
• Fatigue

Question 5

Clinical Signs on Examination of HF?

Answer 5

• tachy
• tachypnoea
• hypertension
• murmurs
• 3rd heart sound
• lateral basal crackles
• raised JVP
• peripheral odema