Chronic Heart Failure

Question 1

Definition

Answer 1

Heart failure is a complex clinical syndrome of symptoms and sigfns that suggest impairement of the heart as a pump supportig physiological circulation. it is caused by structural or functional abnormalities of the hear. The eonstration of objective evidence of these cardiac abnormalities is necessarry for the diagnosis of heart failure to be made.

Question 2

definition 2

Answer 2

•Heart Failure with reduced ejection fraction(LVSD)
•Heart Failure with normal/preserved ejection
fraction(HFNEF/HFPEF/DHF) – increasing with rise of prevalence of
hypertension, diabetes mellitus, atrial fibrillation, obesity

Question 3

RAS?

Answer 3

Question 4

frank starling relationship and inotrpes?

Answer 4

positive inotropes - increase stroke volume

negative inotrope - decrease stroke volume

Question 5

symptoms of HF

Answer 5

— Can be specific or non specific, including shortness of
breath, lethargy, peripheral and central oedema, etc.
— Elevated JVP
— Displaced apex beat
— Basal rales/crepitations on auscultation.
— Peripheral oedema and ascites.

Question 6

hf investigations?

Answer 6

Urgent referral(within 2 weeks) for transthoracic
echocardiography, in patients with previous
myocardial infacrtion and symptoms of heart failure.
— In patients with no previous myocardial infarction,
perform biomarkers: BNP or NTproBNP.
— If levels of BNP/NTproBNP very high, refer for
urgent(within 2 weeks) echocardiography

Question 7

algorithm for heart failure??

Answer 7

Question 8

ecg findings for heart failure?

Answer 8

LVH, LBBB and RBBB

Question 9

treatment for HF?

Answer 9

1. lifestyle
2. pharmacol
3. invasive procedures
4. treatment algorithm

Question 10

change in lifestyle?

Answer 10

— Exercise training
— Smoking
— Alcohol
— Diet and nutrition
— Natural supplementary therapies
— Sexual activities
— Vaccination(influenza, pneumococcal)
— Air travel
— Driving regulations

Question 11

pharmacology?

Answer 11

All patients should be offer an ACE inhibitor and betablocker licensed for heart failure.
— After the above, consider adding:
An aldosterone antagonist in symptomatic patients
(NYHA III and IV and previous MI in last month)
OR
an angiotension receptor blocker in moderate heart
failure(NYHA II-III)
OR
Hydralazine and nitrate(especially in Africo-carribeans) in
severe heart failure( NYHA III-IV)

Question 12

invasive procedures?

Answer 12

— Cardiac Resynchronisation Therapy (CRT)
— Implantable cardiac defibrillator
— Cardiac transplantation
— Left ventricular assist device
— Coronary intervention
— Valvular surgery

Question 13

algorithm for treatment of heart failure

Answer 13

Question 14

cardiomyopathies?

Answer 14

HCM

DCM

ARVD

HCM

RCM

EMF (OCM)