Chronic heart failure (CHF)

Question 1

1) What is chronic heart failure?
2) What is diastolic heart failure?
3) What is systolic heart failure?
4) Name a symptom of left ventricular failure
5) Name a cause of right ventricular failure
6) Name a symptom of right ventricular failure
7) What is low output cardiac failure?

Answer 1

1) Inadequate cardiac output for the body’s requirement that develops/progresses slowly
2) Inability of the ventricle to relax and fill normally causing increased filling pressures
3) Inability of the ventricle to contract fully resulting in a decreased cardiac output
4) Dyspnoea, exercise intolerance, paroxysmal nocturnal dyspnoea, fatigue, orthopnoea, wheeze, peripheral oedema
5) Left ventricular failure, lung disease, pulmonary stenosis
6) Peripheral oedema, ascites, nausea, anorexia
7) Cardiac output is decreased and fails to increase during exertion

Question 2

Diagnosis
1) What blood test is important in the diagnosis of CHF?
2) What is the key investigation for CHF?
3) Name another investigation that may be used
4) What is the ABCDE of CHF features that may be found on a chest x-ray

Answer 2

1) B-type-natriuretic peptide
2) Echocardiography
3) Chest x-ray, ECG
4) Alveolar oedema, kerley B lines (septal lines), cardiomegaly, dilated prominent upper lobe veins and pleural effusion

Question 3

Name 2 causes of CHF

Answer 3

• Ischaemic heart disease
• Valvular heart disease, commonly aortic stenosis
• Hypertension
• Arrhythmias, commonly atrial fibrillation

Question 4

Name 2 things that’s important apart from the medical management of CHF

Answer 4

• Yearly flu and pneumococcal vaccine
• Smoking cessation, alcohol cessation, weight management, eat less salt
• Treatment of causes i.e. valve disease, arrhythmias
• Optimisation of treatment of comorbidities i.e. anaemia

Question 5

What is the medical management of CHF (ABAL)?

Answer 5

A - ACE inhibitor
B - Beta blocker
A - Aldosterone antagonist when symptoms aren’t controlled by A + B
L - Loop diuretic

Question 6

If symptoms persist despite optimal treatment, advice from a heart failure specialist should be sought on the use of other drugs - name 2 of these

Answer 6

• Amiodarone hydrochloride
• Digoxin
• Ivabradine
• Dapagliflozin, empagliflozin
• Sacubitril with valsartan

Question 7

Name 2 groups of drugs/drugs that are known to prolong survival in CHF

Answer 7

• ACE inhibitors and ARBs
• Spironolactone and other aldosterone antagonists
• Beta blockers
• Hydralazine and nitrates