Definations and Diagnosis of Heart Failure

Question 1

Heart Failure is

Answer 1

A common complex syndrome resulting from the inability of the ventricle to fill with or eject blood
Occurs at the end-stage of many cardiac conditions
Has a high morbidity and mortality

Question 2

Heart Failure is characterised by

Answer 2

Fatigue
Dyspnoea
Fluid retention or oedema

Question 3

A Diagnosis of Heart Failure-Reduced Ejection Fraction requires:

Answer 3

• typical symptoms of HF
• typical signs of HF
• Reduced ejection fraction

Question 4

A Diagnosis of Heart Failure-Perserved Ejection Fraction requires

Answer 4

• typical symptoms of HF
• typical signs of HF
• Normal or only mild reduced LVEF and LV not dilated
• Structural heart disease or diastolic dysfunction

Question 5

Prevalence of HF in the UK

Answer 5

1 million people have heart failure

1 million people have asymptomatic LV dysfunction

Question 6

Mortality of HF

Answer 6

40% die in the first year
- 50% without treatment
- 10% with optimal treatment
10% per year after that

Question 7

Burden of HF

Answer 7

2% of all inpatient beds
5% of emergency admissions
2% of NHS budget
50% predicted rise in admissions over the next 20 years

Question 8

Diagnosis

Answer 8

Average age 76 after acute admission

- clinical accuracy 40% at best

Question 9

Biochemical Tests for HF

Answer 9

Normal BNP/NTproBNP level has a high negative predictive value (if positive still 50% chance not HF)
ECG and CXR are essential, but variable

Question 10

When should refer for an echo

Answer 10

When a patient’s with signs/symptoms has:

• Previous MI
• BNP >400pg/ml or NTproBNP > 2000pg/ml

Question 11

If BNP between 100-400 pg/ml or NTproBNP is between 400-2000 pg/ml

Answer 11

Refer for a non-urgent echo within 6 weeks

Question 12

Diastolic HF

Answer 12

Signs and symptoms of HF with preserved systolic function
Echo evidence of raised filling pressure, high BNP and atrial arrythmias
Occurs in 1/3 of all patients presenting with HF with similar prognosis

Question 13

Diastolic HF is more common in

Answer 13

Elderly
Diabetic
Hypertensive
Africans or Asians

Question 14

Clinical HF with high BNP but normal echo may be

Answer 14

Pericardial constriction
Myocardial restriction
Coronary artery disease
Pulmonary hypertension
Arrythmias

Question 15

What is cor pulmonale

Answer 15

Right heart failure caused chronic pulmonary arterial hypertension

Question 16

Findings in a cardiac exam in cor pulmonale

Answer 16

Raised JVP w/prominent a and v waves
RV heave
Pansystolic murmur (tricusp regurg)
Graham steell murmur

Question 17

Lung disease causes of cor pulmonale

Answer 17

COPD
Bronchiectasis 
Pulmonary fibrosis
Severe chronic asthma
Lung resection

Question 18

Pulmonary vascular disease causes of cor pulmonale

Answer 18

PE
Vasculitis
Primary pulmonary hypertension 
ARDS
SCD
Parasite infestation (roundworm, lungworm etc)

Question 19

Thoracic cage abnormalities leading to cor pulmonale

Answer 19

Kyphosis
Scoliosis
Thoracoplasty

Question 20

Neuromuscular disease causes of cor pulmonale

Answer 20

MG
Polio
MND