Heart Failure

Question 1

What is HF caused by?

Answer 1

*HF is caused by structural and/or cardiac abnormality and results in reduced cardiac output and/or elevated intracardiac pressures at rest or during stress

Question 2

What are signs of HF?

Answer 2

typical symptoms (e.g. breathlessness, ankle swelling and fatigue) that may be accompanied by signs (e.g. elevated jugular venous pressure, pulmonary crackles, peripheral oedema)

Question 3

What are the stages of HF according to the ACC?

Answer 3

Question 4

What are the types of HF?

Answer 4

Question 5

What are the classes of HF according to the NYHA?

Answer 5

Question 6

What investigations should be carried out in a patient with suspected chronic HF?

Answer 6

• FBC
• Fasting blood glucose
• U&Es
• Urinalysis
• TFTs
• ECG
• Cxr

Question 7

Diagnosing HF

Answer 7

After clinical examination and exclusion of other causes patients with suspected HF should have NT-proBNP type levels checked (closely linked with prognosis).

Refer people with suspected HF and an NT-proBNP level >2000 urgently for suspected assessment and ECHO (ideally <2 weeks)

Refer people with suspected HF and NT=proBNP level between 400-2000 to have special assessment and ECHO within 6 weeks

NT <400 in an untreated person makes diagnosis of HF unlikley.

Tests:
Echo
Cardiac MRI
LV angiography

Question 8

What is the treatment of HF-REF?

Answer 8

Question 9

Why are diuretics used in treatment?

Answer 9

To give rapid improvement in clinical symptoms (e..g. odema, SOB, farigue, raised JVP, lung crackles)

Question 10

Which patients are diuretics reccomended in?

Answer 10

Patients with HF-REF and clinical signs of congestion including
* odemea
* SOB
* PND/orthopnoea
* raised JVP
* weight increased
* incresed cardiac pressures

Question 11

When are diuretcis used in treatement of HF-REF

Answer 11

first-line (generally when diagnosis still being confirmed)

Question 12

Which diuretic is preferred?

Answer 12

Loop diuretic due to rapid onset of action e.g. furosemide or bumetanide

Question 13

Which diuretic is preferred?

Answer 13

Loop diuretic due to rapid onset of action e.g. furosemide or bumetanide

Question 14

How should diuretics be used?

Answer 14

Start low dose furosemide (e.g. 40mg) and increase in increments of 40mg until clinical improvement in symptoms.

Patients with severe symptoms at present may need higher inital starting dose or IV therapy.

If patient needs furosemide 8-mg BF or bumetanide 2mg BD and still has sign of congestion the seek specialist advice and consider combinatio diuretics (e.g. ass in thiazide)

Question 15

Safety monitoring for diuretics

Answer 15

BP and RF before treatment and rechecked 1-2 weeks after initation and dose increase

Question 16

Monitroing response to diuretic

Question 17

Why are ACEi used for treatment of HF

Answer 17

improves survival, decreases cardiac hospitalisation and improves symptoms

Question 18

Which patients whould ACEi or ARB used for HF

Answer 18

REccomended in all HF-REF irrespective of symptoms

Question 19

When should ACEi be initated in HF treatment

Answer 19

first-line

Question 20

Which ACEi or ARB should be used?

Answer 20

Any generic formulaty based is fine

E.g. ramipril, enalapril, lisinopril, captopril

E.g. Candesartan, lorsartan or valsartan

Question 21

How should ACEi/ARB be used?

Answer 21