Chronic heart failure

Question 1

What is chronic heart failure?

Answer 1

It is clinical syndrome with dyspnoea, fatigue and fluid retention due to cardiac dysfunction both either at rest or on exertion with accompanied neurohormonal activation, inadequate cardiac output

Question 2

What are some possible causes of chronic heart failure?

Answer 2

LV systolic dysfunction, ischaemic heart disease, MI, severe aortic stenosis, cardiomyopathy, cardiac tamponade, hypertension, restrictive pericarditis etc

Question 3

What are the risk factors for chronic heart failure?

Answer 3

Obesity, diabetes, hypertension, coronary artery disease, valvular heart disease, alcoholism, infection viral mainly, congenital heart defect, obstructive sleep apnoea, age, smoking, high or low hematocrits levels

Question 4

What is the prognosis for heart failure?

Answer 4

very bad prognosis, similar to cancer

Question 5

What are to different types of heart failure based on their function?

Answer 5

Systolic and diastolic heart failures, they very often co-exist

Question 6

What are the types of heart failure based on the location?

Answer 6

Right side, left sided, combined in congestive heart failure

Question 7

What are the symptoms of left sided heart failure ?

Answer 7

Dyspnoea, lower exercise tolerance, fatigue, cough, pinky frothy sputum, orthopnoea, paroxysmal nocturnal dyspnoea, cold peripheries, muscle waisting, weight loss, wheeze

Question 8

What are the symptoms of right sided heart failure?

Answer 8

peripheral oedema, ascites, pulsation in neck and facial nausea, anorexia, facial engorgement,

Question 9

What are the signs of heart failure?

Answer 9

Raised JVP, S3, peripheral, sacral oedema, crackles from pulmonary effusion, cardiac wheeze, displaced apex beat, RV heave, cold peripheries, peripheral cyanosis, tachycardia, narrow pulse pressure

Question 10

What are the investigations performed for cardiac failure ?

Answer 10

Bloods (FBC, U+E, BNP), ECG, echo, chest X ray, radionuclide ventriculography, left ventriculography

Question 11

What are the three echo views?

Answer 11

Parasternal long axis, parasternal short axis and parasternal base

Question 12

What is required for diagnosis?

Answer 12

signs and symptoms, evidence of cardiac dysfunction and responsiveness to diuretics

Question 13

What is the screening for heart failure?

Answer 13

Measurement of brain natriuretic peptide, it is low in healthy patients, elevated in heart failure

Question 14

Name some important causes of LV dysfunction

Answer 14

ischaemic heart disease, dilated cardiomyopathy, severe aortic stenosis, mitral regurgitation, MI, toxins such as alcohol, catecholamines, muscular dystrophies, viral infections

Question 15

What are the different types of ejection fraction?

Answer 15

normal 50-80%, mild 40-50%, moderate 30-40%, severe less than 3-%

Question 16

What is the name of the method that is commonly used to measure ejection fraction?

Answer 16

Biplane modified Simpsons’s rule

Question 17

What is the grading system used for cardiac failure?

Answer 17

NYHA class I to IV, it is based on symptoms

Question 18

Define the 4 stages of heart failure

Answer 18

class I no limitations to exercise, no symptoms during usual activity, class II mild militating, comfortable at rest and mild exertion, class III moderate limitations to exercise, comfortable only at rest, class IV severe exercise limitations, any physical activity brings discomfort

Question 19

What is the pathology of heart failure?

Answer 19

It is very complex, it is systemic disorder not just about CO, there is cardiac dysfunction, renal blood flow dysfunction, systemic inflammation, neurohormonal activation that is maladaptive, skeletal dysfunction, activation of sympathetic system and RAAS

Question 20

What is HFrEF?

Answer 20

Heart failure with reduced ejection fraction, it is systolic heart failure

Question 21

What is HFPEF?

Answer 21

Heart failure with preserved ejection fraction

Question 22

What happens to Frank-Starlings law in heart failure?

Answer 22

The Frank-Starling law is lost in heart failure, more preload causes more dilation in the heart, as the heart dilates more the contraction is weaker and therefore less blood is pumped out, this causes activation of sympathetic system and kidneys which cause blood retention, again preload is increased and the same cycle repeats

Question 23

What pathological changes occur as a result of activation of RAAS and sympathetic system?

Answer 23

hypertrophy of heart muscle, vasoconstriction and fibrosis of myocytes

Question 24

Which factors are vasodilating?

Answer 24

EDFR and ANP, BNP, atrial and brain natriuretic peptides

Question 25

What treatment is given to improve symptoms of heart failure ?

Answer 25

diuretics and digoxin

Question 26

What treatment does improve the symptoms and survival?

Answer 26

ACE inhibitors, spironolactone

Question 27

What treatment does improve the survival ?

Answer 27

Beta blockers, ivabradine

Question 28

What diuretics are used and how do they work?

Answer 28

Furosemide and butamatine are the most common, they remove excess salt and water, they inhibit Na-K-Cl transporters in loop of henle, significant diuresis is produced, it causes symptomatic relief

Question 29

What treatment if given to patients who are diuresis resistant?

Answer 29

Combination of loop diuretics and thiazide like diuretics