Chronic Heart Failure Flashcards
What is chronic heart failure (CHF)?
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.
What are the main types of heart failure?
Heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF).
What are the common symptoms of CHF?
Breathlessness (exertional or at rest), orthopnoea, paroxysmal nocturnal dyspnoea, fatigue, ankle swelling, and reduced exercise tolerance.
What is the aetiology of CHF?
Common causes include coronary artery disease, hypertension, valvular heart disease, arrhythmias, and cardiomyopathy.
What is the pathophysiology of HFrEF?
It involves impaired myocardial contractility leading to reduced cardiac output and activation of compensatory mechanisms like the renin-angiotensin-aldosterone system (RAAS).
What is the pathophysiology of HFpEF?
It involves impaired ventricular relaxation and filling due to stiffness of the ventricular walls, leading to increased filling pressures and pulmonary congestion.
What are the risk factors for CHF?
Age, hypertension, diabetes, coronary artery disease, smoking, obesity, and a family history of heart disease.
What are the signs of CHF on physical examination?
Raised jugular venous pressure (JVP), peripheral oedema, pulmonary crackles, tachycardia, and displaced apex beat.
What investigations are used to diagnose CHF?
ECG, echocardiography, chest X-ray, B-type natriuretic peptide (BNP) levels, and blood tests including renal function and thyroid function tests.
What does an elevated BNP level indicate in CHF?
It reflects increased cardiac wall stress and is used to help diagnose or exclude heart failure.
What are the typical chest X-ray findings in CHF?
Cardiomegaly, pulmonary oedema, Kerley B lines, pleural effusions, and vascular redistribution.
How is echocardiography used in CHF?
Echocardiography assesses ejection fraction, wall motion abnormalities, and structural heart defects like valve disease.
What is the role of the New York Heart Association (NYHA) classification in CHF?
It grades the severity of heart failure symptoms into four functional classes based on physical activity limitations.
What are the common causes of decompensated CHF?
Infection, arrhythmias, myocardial ischaemia, uncontrolled hypertension, and non-compliance with medications or fluid restrictions.
What are the differential diagnoses for CHF?
Chronic obstructive pulmonary disease (COPD), pulmonary hypertension, anaemia, renal failure, and obesity.
What are the goals of CHF management?
To relieve symptoms, improve quality of life, reduce hospitalisations, and decrease mortality.
What is the first-line medical therapy for HFrEF?
Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) and beta-blockers.
What additional medical therapies may be used in HFrEF?
Mineralocorticoid receptor antagonists (e.g., spironolactone), diuretics for symptomatic relief, and sodium-glucose co-transporter 2 (SGLT2) inhibitors.
What is the role of diuretics in CHF?
Diuretics, like furosemide, provide symptomatic relief by reducing fluid overload but do not improve mortality.
How is HFpEF managed?
Management focuses on treating comorbidities like hypertension and atrial fibrillation, as well as optimising diuretic therapy for fluid overload.
What lifestyle changes are recommended for CHF patients?
Dietary salt restriction, fluid intake monitoring, smoking cessation, weight management, and regular physical activity tailored to tolerance.
What are the surgical options for CHF?
These include coronary revascularisation (e.g., CABG), valve repair or replacement, and implantation of devices like ICDs or CRT.
What complications can arise from CHF?
Arrhythmias, thromboembolism, renal dysfunction, and cardiogenic shock.
How is decompensated CHF managed acutely?
Oxygen therapy if hypoxic, IV diuretics, vasodilators (e.g., nitrates), and addressing precipitating factors like infection or arrhythmias.
