Chronic Heart Failure

Question 1

Define heart failure?

Answer 1

A clinical syndrome compromising of dyspnoea, fatigue or fluid retention due to cardiac dysfunction, either at rest or on extertion with accompanying neurohormonal activation

Question 2

What is the prevalence of heart failure?

Answer 2

0.4-2%

Question 3

What are the factors affecting prevalence of CHF?

Answer 3

Aging of population
Hypertension
Obesity
Diabetes

Question 4

What is the survival rate of chronic heart disease after one year?

Answer 4

60% approx

Question 5

What are they symptoms of heart disease?

Answer 5

• Breathlessness
• Fatigue
• Oedema
• Reduced exercise capacity

Question 6

What are the signs of heart disease?

Answer 6

• Oedema
• Tachycardia
• Raised JVP
• Chest crepitations or effusions
• 3rd heart sound
• Displaced or abnormal apex beat

Question 7

How can one diagnose heart failure?

Answer 7

1. Symtoms or signs
2. Objective evidence of cardiac dysfunction
3. Response to therapy (if doubtful)

Question 8

What is the most used way of diagnosing CHF ?

Answer 8

Echocardiogram

Question 9

What else can a echocardiogram be used for?

Answer 9

Mumurs,
valve
AF
MI

Question 10

What are two potential screening tests?

Answer 10

12 lead ECG

BNP

Question 11

What does BNP stand for?

Answer 11

Brain (btype) natriuretic peptide)

Question 12

What is BNP used for?

Answer 12

An Amino acid peptide, can be measured easily in blood

Evlevated in heart failure

Question 13

What causes CHF?

Answer 13

If sufficiently severe almost any strctural cardiac abnormality will cause heart failure

Question 14

What causes LV systolic dysfunction?

Answer 14

• Ischaemic heart disease (usually MI)

- Dilated cardiomyopathy (DCM)

Question 15

What is dilated cardiomyopathy?

Answer 15

Means LVSD not due to IHD or secondary to other lesion.

Eg toxins/viral/systemic diseases

Question 16

Echocardiography: why is it an essential investigation?

Answer 16

• Identify & quantify
• LVSD
• Valvular dysfunction
• Pericardial effusion/tamponade
• Diastolic dysfunction
• LVH
• Atrial/ventricular shunts/complex congenital heart defects
• Pulmonary hypertension/ right heart dysfunction

Question 17

What can evade an echocardiogram?

Answer 17

May not identify constriction/may miss shunts

Question 18

What is the LV ejection fraction?

Answer 18

biological variable
blood pumped out from heart
normally 55%-70%

Question 19

What is analogous to Lv ejection fraction?

Answer 19

Haemoglobin

Question 20

What are the classifications and values of ejection fractions?

Answer 20

• Normal=50-80%
• Mild=40-50%
• Moderate=30-40%
• Severe=<30%

Question 21

Whats the easiest way to find LVEF?

Answer 21

Multigated Acquisition (medical exam used to calculate the left ventricular ejection fraction) scan

Question 22

Info about MUGA?

Answer 22

Multigated Acquisition

• greater reproductibility
• Ionising radiation
• No additional structure information
• Centre specific normal range

Question 23

What are thebrackets of the New York Association classification?

Answer 23

1= No limitation
2=comfortable at rest or mild exertion
3=comfortable only at rest
4=Any physical activity brings on discomfort and symptoms occur at rest

Question 24

Does Heart failure equal cardiac output?

Answer 24

NOOOOOOOOOOO

OOOOOOOOOOOO

Question 25

What does heart failure effect?

Answer 25

Cardiac dysfunction
Renal dysfunction
skeletal muscle dysfunction
systemic inflammation
Neurohormonal activation

Question 26

What is the pharmacological therapy for heart failure (LVSD)?

Answer 26

Diuretics 
ACE inhibitors
Betablockers
Aldosteroine receptor blockers
ARBS (angiotensin 2 receptor blockers)
ARNI ( angiotensin receptors neprilvisin (breaks down (BNP) inhibitor.