Chronic Heart Failure

Question 1

What is chronic heart failure (CHF)?

Answer 1

Chronic heart failure is a long-term condition in which the heart is unable to pump blood efficiently to meet the body’s needs, leading to symptoms like breathlessness and fatigue.

Question 2

What are the main types of heart failure?

Answer 2

Heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF).

Question 3

What are the common symptoms of CHF?

Answer 3

Breathlessness (exertional or at rest), orthopnoea, paroxysmal nocturnal dyspnoea, fatigue, ankle swelling, and reduced exercise tolerance.

Question 4

What is the aetiology of CHF?

Answer 4

Common causes include coronary artery disease, hypertension, valvular heart disease, arrhythmias, and cardiomyopathy.

Question 5

What is the pathophysiology of HFrEF?

Answer 5

It involves impaired myocardial contractility leading to reduced cardiac output and activation of compensatory mechanisms like the renin-angiotensin-aldosterone system (RAAS).

Question 6

What is the pathophysiology of HFpEF?

Answer 6

It involves impaired ventricular relaxation and filling due to stiffness of the ventricular walls, leading to increased filling pressures and pulmonary congestion.

Question 7

What are the risk factors for CHF?

Answer 7

Age, hypertension, diabetes, coronary artery disease, smoking, obesity, and a family history of heart disease.

Question 8

What are the signs of CHF on physical examination?

Answer 8

Raised jugular venous pressure (JVP), peripheral oedema, pulmonary crackles, tachycardia, and displaced apex beat.

Question 9

What investigations are used to diagnose CHF?

Answer 9

ECG, echocardiography, chest X-ray, B-type natriuretic peptide (BNP) levels, and blood tests including renal function and thyroid function tests.

Question 10

What does an elevated BNP level indicate in CHF?

Answer 10

It reflects increased cardiac wall stress and is used to help diagnose or exclude heart failure.

Question 11

What are the typical chest X-ray findings in CHF?

Answer 11

Cardiomegaly, pulmonary oedema, Kerley B lines, pleural effusions, and vascular redistribution.

Question 12

How is echocardiography used in CHF?

Answer 12

Echocardiography assesses ejection fraction, wall motion abnormalities, and structural heart defects like valve disease.

Question 13

What is the role of the New York Heart Association (NYHA) classification in CHF?

Answer 13

It grades the severity of heart failure symptoms into four functional classes based on physical activity limitations.

Question 14

What are the common causes of decompensated CHF?

Answer 14

Infection, arrhythmias, myocardial ischaemia, uncontrolled hypertension, and non-compliance with medications or fluid restrictions.

Question 15

What are the differential diagnoses for CHF?

Answer 15

Chronic obstructive pulmonary disease (COPD), pulmonary hypertension, anaemia, renal failure, and obesity.

Question 16

What are the goals of CHF management?

Answer 16

To relieve symptoms, improve quality of life, reduce hospitalisations, and decrease mortality.

Question 17

What is the first-line medical therapy for HFrEF?

Answer 17

Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and beta-blockers.

Question 18

What additional medical therapies may be used in HFrEF?

Answer 18

Mineralocorticoid receptor antagonists (e.g., spironolactone), diuretics for symptomatic relief, and sodium-glucose co-transporter 2 (SGLT2) inhibitors.

Question 19

What is the role of diuretics in CHF?

Answer 19

Diuretics, like furosemide, provide symptomatic relief by reducing fluid overload but do not improve mortality.

Question 20

How is HFpEF managed?

Answer 20

Management focuses on treating comorbidities like hypertension and atrial fibrillation, as well as optimising diuretic therapy for fluid overload.

Question 21

What lifestyle changes are recommended for CHF patients?

Answer 21

Dietary salt restriction, fluid intake monitoring, smoking cessation, weight management, and regular physical activity tailored to tolerance.

Question 22

What are the surgical options for CHF?

Answer 22

These include coronary revascularisation (e.g., CABG), valve repair or replacement, and implantation of devices like ICDs or CRT.

Question 23

What complications can arise from CHF?

Answer 23

Arrhythmias, thromboembolism, renal dysfunction, and cardiogenic shock.

Question 24

How is decompensated CHF managed acutely?

Answer 24

Oxygen therapy if hypoxic, IV diuretics, vasodilators (e.g., nitrates), and addressing precipitating factors like infection or arrhythmias.

Question 25

Why is regular follow-up important in CHF?

Answer 25

To monitor symptoms, optimise medical therapy, assess for complications, and provide patient education on self-management.