Heart Failure

Question 1

Given a general definition for 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

Heart failure is not the final diagnosis- how can it be qualified?

Answer 2

By the underlying structural abnormality

For example, heart failure due to left ventricular systolic dysfunction due to ischemic heart disease

Question 3

What are some of the risks/ conditions which can increase risks of heart failure?

Answer 3

Increasing age
Diabetes
Hypertension
COPD
Obesity

Question 4

In those with conditions which can increase chances of heart failure, how can these risks be reduced?

Answer 4

Treatment of the underlying condition

Question 5

What are some of the initial symptoms of heart failure?

Answer 5

Breathlessness
Fatigue
Oedema
Reduced exercise capability

Question 6

What are some of the initial clinical signs which may be suggestive of heart failure?

Answer 6

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

Question 7

Which investigation can help to diagnose heart failure and why?

Answer 7

Chest x-ray
Can show gross cardiomegaly and pleural effusions and oedema

Question 8

According to the European soc cardiology guidelines, what are the three factors a patient must have in order to be diagnosed with heart failure?

Answer 8

1. Symptoms/signs of HF, either at rest or upon exercise
2. Objective evidence of cardiac dysfunction
3. Responds to diuretics (this one is only important when unsure about making a diagnosis)

Question 9

How can objective evidence be obtained when diagnosing someone with HF?

Answer 9

Using the following investigations-
-Echocardiography
-Radionuclide ventriculography
-MRI
-Left ventriculography

Question 10

What are the two potential ‘screening’ tests used for HF?

->note ‘screening’ as other investigations can have a low waiting list so these are used to get an idea more quickly

Answer 10

12 Lead ECG
BNP- blood test that measures levels of a protein called BNP

Question 11

Why is a 12 lead ECG an effective screening process?

Answer 11

If there are no abnormalities on the ECG, patient is very unlikely to have heart failure.

Question 12

What level of BNP is consistent with HF?

Answer 12

Elevated BNP

Question 13

Which test is considered to be the first line test for patients with suspected HF?

Answer 13

BNP blood test

Question 14

The higher the levels of BNP,….?

Answer 14

The more advanced HF is

Question 15

Which structural abnormalities can cause HF?

Answer 15

Pretty much any structural/ functional cardiac abnormalities.

Here’s a few-
LV systolic dysfunction
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 16

What are the two main groups of causes of LV systolic disfunction?

Answer 16

Ischaemic heart diseases, usually MI
Dilated cardiomyopathy

Question 17

What is dilated cardiomyopathy?

Answer 17

An umbrella term covering left ventricular systolic dysfunction that is not due to ischaemic heart disease or primary valve lesion.

Question 18

What investigations are carried out to diagnose LV systolic dysfunction?

Answer 18

ECG
CXR
ECHO

Question 19

Which investigation is ALWAYS carried out when diagnosing LV systolic dysfunctions?

Answer 19

ECHO

Question 20

When would it be especially important to consider coronary angiography in patients with suspected LV systolic dysfunction?

Answer 20

If they have chest pain- especially if younger

Question 21

Why might CT coronary angiogram be considered instead of cor angio?

Answer 21

Less invasive as does require insertion of a catheter

Question 22

What is one way of assessing how damaged the left ventricle is?

Answer 22

Assessing the left ventricular ejection fraction

Question 23

Is LV ejection fraction a continuous or discrete biological variable?

Answer 23

Continuous

Question 24

What is one issue with using LV ejection fraction to assess damage to the left ventricle?

Answer 24

Cannot be sure of the normal value for the patient.
A high/low level could be normal for them

Question 25

What is a normal LVEF % approx?

Answer 25

55-70%

Question 26

What is a mild LVEF % approx?

Answer 26

40-55%`

Question 27

What is a moderate LVEF % approx?

Answer 27

30-40%

Question 28

What is a severe LVEF % approx?

Answer 28

<30%

Question 29

What scan is an accurate way of getting a LVEF measurement?

Answer 29

MUGA scan

Question 30

Is Cardiac MRI more accurate than ECHO?

Answer 30

Yes

Question 31

What are the disadvantages of cardiac MRI even though it’s more accurate?

Answer 31

-Expensive, time-consuming
-Cannot be done at bedside
-Requires breathholding
-Claustrophobia issues

Question 32

What does grading of HR with the New York Association for HF take into account?

Answer 32

Looks at symtoms

Question 33

What would a NYHA* classification of 1 suggest?

*New York Association

Answer 33

No symptoms during usual acitivty

Question 34

What would a NYHA* classification of 2 suggest?

*New York Association

Answer 34

Comfortable with rest or mild exertion

Question 35

What would a NYHA* classification of 3 suggest?

*New York Association

Answer 35

Comfortable only at rest

Question 36

What would a NYHA* classification of 4 suggest?

*New York Association

Answer 36

Any physical activity brings on discomfort
Symptoms occur at rest