Heart Failure Flashcards
Which trial suggests there is survival benefit with the use of spironolactone in severe heart failure?
A RALES B COMET C DIG D CONSENSUS E EMPHASIS-HF
A - RALES
The RALES trial looked at the role of spironolactone in the treatment of severe heart failure and found it to have survival benefit.
All of the above are important trials looking at the role of different pharmacotherapies in the treatment of cardiac failure. The COMET assessed the role of carvedilol, DIG assessed digoxin, CONSENSUS assessed enalapril, and EMPHASIS-HF assessed eplerenone (another aldosterone antagonist).
A 61 year old is currently an inpatient on a medical ward being treated for infective endocarditis (IE). He has a possible vegetation on one of the aortic valve leaflets and is awaiting a transoesophageal echocardiogram. His blood cultures reveal Streptococcus gallolyticus (formally known as Streptococcus bovis).
What would be important to ask about in this patients history?
A Dental history B Smoking history C Change in bowel habits D Alcohol history E Recent travel history
There is a well established association between Streptococcus gallolyticus (formal known as Streptococcus bovis) and colorectal cancer.
Streptococcus gallolyticus is a group D beta-haemolytic streptococci, which was previously termed Streptococcus bovis. S. bovis was reclassified into different species such as Streptococcus gallolyticus and Streptococcus infantarius, which are further divided into subtypes. S. gallolyticus can be a cause of subacute IE and due to its association with colorectal cancer, patients should be asked about lower GI cancer symptoms including change in bowel habit, bleeding and weight loss. Depending on fitness, these patients should be referred for a colonoscopy to formally assess the colorectal mucosa.
Which of the following cells are seen in atherosclerosis?
A Merkel cells B Mallory-Denk bodies C Stellate cells D Reed-Sternberg cells E Foam cells
Foam cells are commonly seen in atherosclerosis, which refer to macrophages that have phagocytosed low-density lipoproteins.
There are three main steps to atherosclerosis:
- Endothelial dysfunction: characterised by local inflammation, low-density lipoprotein (LDL) accumulation and generation of reactive oxygen species.
- Plaque formation: characterised by attraction of macrophages that phagocytose LDLs and become foam cells, seen as ‘fatty streaks’. Smooth muscle cells migrate and form a fibrous cap. Leads to vessel narrowing
- Plaque rupture: the fibrous cap and fatty streaks form an atheroma with a hard plaque. If the endothelial lining of the plaque ruptures it exposes the collagen-rich cap leading to platelet aggregation and sudden vessel occlusion (seen in ACS).
Which of the following is the most common cause of heart failure in the UK?
A Atrial fibrillation B Ischaemic heart disease C Dilated cardiomyopathy D Hypertension E Mitral stenosis
The most common cause of congestive cardiac failure within the UK is ischaemic heart disease (IHD), which accounts for 35-40% of cases.
The second most common is dilated cardiomyopathy, which occurs in 30% of cases.
Echocardiography allows assessment of left ventricular function and estimation of the ejection fraction. An ejection fraction between …% is considered normal.
Echocardiography allows assessment of left ventricular function and estimation of the ejection fraction. An ejection fraction between 55-70% is considered normal.
NICE recommends that patients with evidence of heart failure should undergo a … measurement and if elevated referred for specialist assessment.
NICE recommends that patients with evidence of heart failure should undergo a BNP measurement and if elevated referred for specialist assessment.
BNP is released when there is an excessive stretch on the cardiomyocytes. The levels of BNP may be affected by other causes of cardiac dysfunction (e.g. left ventricular hypertrophy, ischaemia, tachycardia), obesity, and pharmacotherapies (e.g. ACE-i, beta-blockers). Patients with a raised BNP level should be referred for formal …
BNP is released when there is an excessive stretch on the cardiomyocytes. The levels of BNP may be affected by other causes of cardiac dysfunction (e.g. left ventricular hypertrophy, ischaemia, tachycardia), obesity, and pharmacotherapies (e.g. ACE-i, beta-blockers). Patients with a raised BNP level should be referred for formal echocardiography.
A 69-year-old presents to the GP with progressive shortness of breath. He is struggling to manage his stairs at home and has noticed both legs becoming more swollen. He denies any recent or current chest pain. He has a background of hypertension and atrial fibrillation. On examination there are bibasal crepitations on auscultation of the lung bases and peripheral oedema. Both heart sounds are present without any added sounds. The GP suspects this could be heart failure.
What is the most appropriate initial investigation?
A Cardiac MRI B CT chest C Urinary protein:creatinine ratio D NT-proBNP E Troponin
Measure N-terminal pro-B-type natriuretic peptide (NT-proBNP) in people with suspected heart failure.
A 58-year-old gentleman is transferred for percutaneous coronary intervention following an ST-elevation myocardial infarction (STEMI). He has a past medical history of hypertension, diabetes mellitus and hypercholesterolaemia. He is found to have ST-elevation in leads II, III, and aVF on a standard 12-lead ECG.
Which coronary vessel is most likely to be affected?
A Left main stem B Left anterior descending (LAD) C Circumflex artery (Cx) D Right coronary artery (RCA) E Coronary sinus
RCA
A 91-year-old female, with known congestive cardiac failure, is seen by the GP with increasing shortness of breath. She is now getting breathless while at rest and requiring an increasing amount of support at home.
What is this patient’s New York Heart Association (NYHA) functional classification stage?
A 0 B I C II D III E IV
The NYHA functional classification is a simple tool that can be used to help grade the severity of heart failure based on patient symptoms. The score places patients in one of four categories based on their functional limitation, which is quantified by breathlessness.
I - Cardiac disease, but no symptoms and no limitations in ordinary physical activity
II - Mild symptoms on ordinary activity
III - Marked limitation on minimal activity, but comfortable at rest
IV - Severe limitations experienced at rest
HF A-E on CXR
