Heart failure

Question 1

What is heart failure ?

Answer 1

A clinical syndrome comprising of dyspnoea, fatigue or fluid retention due to cardiac dysfunction, either at rest or on exertion, with accompanying neurohormonal activation’’

Question 2

What is the prevalence of heart failure ?

Answer 2

2% at 50 years
10% at 80 years
Increases with age

Question 3

What is the mortality rate of heart failure ?

Answer 3

50% at 50 years

Question 4

What is the most commonest cause of heart failure ?

Answer 4

Ischaemic heart disease

Question 5

What drugs can cause heart failure ?

Answer 5

Chemotherapy

Alcohol

Question 6

How does valvular dysfunction cause heart disease ?

Answer 6

Predominantly diastolic dysfunction
AS-> pressure overload-> LVH
AR/MR-> volume overload-> cardiomegaly

Question 7

How does cardiomyopathy cause heart failure ?

Answer 7

HOCM: LVH and outflow obstruction
Dilated: drug-induced or post-viral
Restrictive: MI

Question 8

How does high output failure cause heart failure ?

Answer 8

Hyperdynamic circulation

Uses a lot of ATP

Question 9

What pericardial diseases cause heart failure ?

Answer 9

Pericardial infiltration and effusions

Question 10

What is the symptoms of heart failure ?

Answer 10

SOB
Fatigue
Oedema
Reduced exercise capacity

Question 11

What are the signs of heart failure ?

Answer 11

Oedema
Tachycardia
Raised JVP
Chest creps or effusions
3rd heart sound 
Displaced or abnormal apex beat

Question 12

What is the European soc cardiology guideline ?

Answer 12

1. Symptoms or signs of HF (rest or exercise) and
2. Objective evidence of cardiac dysfunction and (in doubtful cases)
3. Response to therapy (diuretics)

Question 13

What are the potential screening tests for heart failure ?

Answer 13

12 lead ECG

BNP (brain-Btype natriuretic peptide)

Question 14

What other structural cardiac abnormalities will cause heart failure ?

Answer 14

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

Question 15

What are the causes of LV systolic dysfunction ?

Answer 15

Ischaemic heart disease
Dilated cardiomyopathy
Severe aortic valve disease or mitral regurgitation

Question 16

What are the causes of LV systolic dysfunction ?

Answer 16

Ischaemic heart disease
Dilated cardiomyopathy
Severe aortic valve disease or mitral regurgitation

Question 17

What is the presentation of LV ejection fraction ?

Answer 17

LV ejection fraction is a continuous biological variable
Disease/ physiological changes can both decrease and increase the LVEF
The LVEF may be lower than previous but not pathologically low
Analogous to haemoglobin/ aneamia
ECHO

Question 18

What is the prognosis of HF ?

Answer 18

The 1 year survival rate for HF is worse than that for cancer of the breast, uterus, prostate and bladder 
Expensive condition
Common hospital admission illness
High re-admission rates
High morbidity and mortality

Question 19

What are the investigations of HF ?

Answer 19

ECG
NT-ProBNP
ECHO
Bloods:
	- FBC
	- U+E
	- Troponin
Cardiomyopathy screen
Urinalysis
CXR
Cardiac MRI

Question 20

What is the treatment of HF ?

Answer 20

Diuretics
ACEI
B-blockers
Aldosterone receptor blocker
Angiotensin receptor and neprolysin inhibitors