chronic heart failure- epidemiolgy. investigation and diagnosis Flashcards
what is the definition of heart failure?
A clinical syndrome comprising of dyspnoea, fatigue
or fluid retention due to cardiac dysfunction, either at
rest or on exertion, with accompanying
neurohormonal activation
what is the prognosis of heart failure?
30-40% mortality at 1 year
what are the factors that are contributing to the increase in prevalence of heart failure?
- treatment of acute myocardial infarction. past MI increases risk of CHF
- aging population
- increased incidence and prevalence of: ypertension, CHD, obesity, diabetes, high cholesterol
what are the symptoms of congestive heart failure?
- dyspnoea
- fatigue
- oedema
- reduced exercise capacity
what are the signs of congestive heart failure
- oedema
- tachycardia
- raised JVP
- chest crepitations or -effusions
- 3rd heart beat
- displaced or abnormal apex beat
what are the 2/3 the two criteria for heart failure to be diagnosed?
- Symptoms or signs of HF (rest or exercise)
and - Objective evidence of cardiac dysfunction
and (in doubtful cases) - Response to therapy (diuretics)
what are the investigations carried out (to obtain objective evidence of cardiac dysfunction) for heart failure?
- ECHO
- Radionucleotide Scan
- Left Ventriculogram
- Cardiac MRI
what are the 2 investigations that can be carried out for screening for congestive heart failure?
12 lead ECG-entirely normal to rule out heart failure
brain natriuretic peptide-elevated in heart failure
what does raised brain natiuretic peptide indicate?
heart failure or left ventricular systolic dilatation. and indicates the need for echo/cardiac assessment
what is the order of investigations and examination for the for the diagnosis of heart failure
- symptoms of signs suggest CHF
- FBC. fasting blood glucose. serum urea and electrolytes, urinalysis, thyroid function and chest x-ray
- BNP and ECG
- if BNP elevated or ECG abnormal
- refer for echocardiography
what are the structural causes of heart failure?
LV systolic dysfunction – many causes
• Valvular heart disease
• Pericardial constriction or effusion
• LV diastolic dysfunction/heart failure with preserved systolic
function/heart failure with normal ejection fraction
• Cardiac arrhythmias: tachy or brady
• Myocardial ischaemia/infarction (usually via LVSD)
• Restrictive cardiomyopathy eg amyloid, HCM
• Right ventricular failure: primary or secondary to pul
hypertension
what is the main causes of left ventricular systolic dysfunction?
-Ischaemic heart disease (usually MI)
- Severe AV disesase or MR
-Dilated cardiomyopathy(DCM): Means LVSD not due to IHD or
secondary to other lesion ie valves/VSD
-hypertension
what are the ways to diagnose LVSD?
1. take detailed history look for: MI, DI, HBP, post partum, alcohol 2. ECG 3. CXR 4. ECHO 5. coronary angigraphy (if chest pain. <70) 6. CT coronary angiography 7. cardiac MRI
what is echocardiography used to determine in CHF?
•Identify and quantify • LV systolic dysfunction • Valvular dysfunction • Pericardial effusion / tamponade • Diastolic dysfunction • LVH • Atrial/ventricular shunts / complex congenital heart defects • Pulmonary hypertension / Right heart dysfunction
what is a normal LV ejection fraction?
50-80%
what is the ejection fraction for mild cardiac failure?
40-50%
hat is the ejection fraction for moderate cardiac failure?
30-40%
What is the ejection fraction for severe cardiac failure?
<30%
what are the investigations done to assess LVEF?
echocardiogram
MUGA
cardiac MRI -gold standard
what are the pros and cons of MUGA over echocardiography for measuring LVEF?
pros Much easier to obtain an accurate figure for the LVEF •Greater reproducibility • centre specific normal range
cons
•Ionising radiation
•No additional structural information
what are the pros and of using cardiac MRI to determine LVEF?
pros • Greater reproducibility • normal range • Added information about Aetiology - Fibrosis - Infiltration - Oedema • can assess valves cons • Time consuming – Approx 1 hour • Patient compliance • Long breath holds • Claustrophobic • Ability to lie flat • Specialist centres • Long waiting lists
what is the new york association classification of heart failure (NYHA) class 1
exercise tolerance-no limitation
symptoms- no symptoms during usual activity
what is the new york association classification of heart failure (NYHA) class 2
exercise-mild limitation
symptoms-comfortable with rest or with mild exertion
what is the new york association classification of heart failure (NYHA) class 3
exercise- moderate limitation
symptoms- comfortable only at rest
