Chronic Heart Failure

Question 1

HF stats

Answer 1

• 1-2% of UK population, increasing in prevalence
• 1/3 readmitted in 2 weeks, 10% in 1 month, and 50% in 3 months, indicating that there were discharged before they were ready
• bad prognosis, unlikely to live for more than 1 year.

Question 2

causes and risk factors of HF

Answer 2

• LV systolic dysfunction (LVEF <40%)
• Ischaemic heart disease
• age
• hypertension
• chronic heart disease
• diabetes
• obesity
• hyperkeratosis lenticularis perstans (HLP)

Question 3

presentation of chronic heart disease

Answer 3

• breathlessness
• acute MI/angina
• cardiac arrest
• AF/ventricular arrhythmia
• cardiomegaly
• edema
• reduced exercise capacity
• tachycardia
• raised JVP
• effusion
• displaced apex beat and third heart sound

Question 4

investigations for HF

Answer 4

• cardiac MRI (gold standard): better than Echo, gadolinium contrast used, also gives clues on aetiology because it allows you to see structures and fibrosis, etc.
• echo
• CXR
• ECG
• left ventriculogram
• radionucleotide ventriculography
• check response to HF therapy
• BNP levels in blood (biomarker for HF, like troponin is for MI)
• MUGA (multigated acquisition scan): for finding LVEF

Question 5

causes of structural heart disease

Answer 5

• genetics (20-25%)
• toxins (alcohol and catecholamines)
• viral disease (myocarditis, dilated myopathy)
• infective diseases (HIV, Lyme’s disease, Chagas disease)
• muscular dystrophy
• systemic disease (sarcoids, systemic lupus, mitochondrial disease)
• hypertension

Question 6

are symptoms specific?

Answer 6

No, things like low ejection fraction, breathlessness, elevated BNP, common in other disease as well. Therefore one of the first steps is to exclude other diseases like renal failure, anaemia, and thyroid syndrome

Question 7

things to look out for in HF

Answer 7

• cardiac tamponade, pericardial effusion
• pericardial constriction
• atrial/ventricular shunts + other congenital defects
• pulmonary hypertension and right heart failure

Question 8

LVEF of normal and dilated heart

Answer 8

Normal: LVEF 60%, EDV 100 mL, 60mL per ejection, 3.6L CO per min
Dilated: LVEF 30%, EDV 200mL, 6L CO per min

Question 9

pharma treatments of HF

Answer 9

• ACEI: ramipril, enalopril
• ARB: candesartan, valsartan
• diuretics: furosemide, bumetanide
• Beta blockers: carvedilor, bisoprolol
• aldosterone receptor blockers: spironolactone, eplerenone
• ARNI (angiotensin receptor neprilysin blocker): entero