Congestive heart failure

Question 1

What is congestive heart failure?

Answer 1

Heart is unable to pump enough blood to meet the metabolic needs of the body because of pathological changes in the myocardium

Question 2

What is systolic failure?

Answer 2

CHF with reduced stroke volume and ejection fraction (EF)

Question 3

What is diastolic failure?

Answer 3

CHF with reduced stroke volume and preserved ejection fraction

Question 4

What are causes of systolic failure?

Answer 4

Ischemic heart disease
Myocardial infarction
Cardiomyopathy

Question 5

What are the causes of diastolic failure?

Answer 5

Ventricular hypertrophy
Constrictive pericarditis 
Tamponade 
Restrictive cardiomyopathy 
*systolic and diastolic causes often overlap

Question 6

What are general clinical features of heart failure?

Answer 6

Nocturia 
Fatigue
Tachycardia, various arrhythmias 
Heart sounds: S3/S4 gallop 
Pulsus alternans (alternating strong and weak pulses (with a regular pulse rhythm)

Question 7

What are the clinical features of right sided heart failure?

Answer 7

Peripheral pitting edema
Jugular venous distention
Hepatojugular reflux:
Hepatic venous congestion (i.e. Hepatosplenomegaly, Abdominal pain, Jaundice, Ascites)

Question 8

What are the clinical features of left sided heart failure?

Answer 8

Dyspnea
Pulmonary edema
Paroxysmal nocturnal dyspnea
Cardiac asthma

Question 9

What is the classification of heart failure?

Answer 9

NYHA functional classification
(Class 1) No limitations of physical activity
(Class 2) Slight limitations of moderate or prolonged physical activity
(Class 3) Marked limitations of physical activity
(Class 4) Confined to bed, discomfort during any form of physical activity

Question 10

How is hypertrophic cardiomyopathy diagnosed?

Answer 10

Echocardiography
ECG
CXR

Question 11

What is the treatment for hypertrophic cardiomyopathy?

Answer 11

(No treatment for asymptomatic patients)
(Medical) Beta-blockers
Duiretics in HCM not HCOM
Implantable cardioverter defibrillator (ICD)
(Surgery) Myectomy (Morrow procedure)

Question 12

What is the treatment for dilated cardiomyopathy?

Answer 12

Treatment of underlying cause
(Treatment of heart failure) Sodium restriction
ACE inhibitors, beta blockers, diuretics, digoxin
(Surgical) Implantable cardioverter defibrillator
Heart transplantation

Question 13

How is dilated cardiomyopathy diagnosed?

Answer 13

Echocardiography
ECG
CXR