Heart failure

Question 1

What is heart failure

Answer 1

Heart failure is a clinical syndrome where the heart is unable to pump blood around the body properly

Question 2

What are the classifications of heart failure and briefly explain

Answer 2

Systolic and Diastolic heart failure

• Systolic heart failure
  When the heart fails to pump blood out of the ventricles fully mainly due to thick and thin cardiac muscles
• Diastolic heart failure
  When the heart fails to fill blood efficiently due to large cardiac muscle, thus reduced ventricle size

Question 3

How is normal Ejected volume/fraction compared to that of a patient with heart failure

Answer 3

% of blood ejected by each beat
Normally 55-70% (under 40% for HF)

Question 4

Discuss the causes of heart failure

Answer 4

Systolic
- Coronary heart disease (due to plaque deposition) – reduced blood supply to the cardiac cells
- Cardiomyopathy (Heart muscle diseases due to several factors) weakens the heart muscles
- Valve diseases
- cardiac arrhythmias

Diastolic
- Hypertension
- Aortic stenosis
- cardiac myopathy
- Disease, alcohol, medications

Question 5

What are symptoms of heart failure

Answer 5

1. Symptoms of left-sided heart failure

. Forward failure
- Tiredness & fatigue
- Decreased urination – due to lack of blood supply & reduce fluid loss
- Irregular heart beats – to supply more blood

. Backward failure
- Pulmonary oedema -
- Difficulty breathing & coughing – due to congestion or fluid build up in lungs
- Weight gain – due to fluid build up

2. Symptoms of right-sided heart failure. Forward failure (can’t pump blood to the lungs)
   - Tiredness & fatigue – reduced supply to the lungs and thus lack of oxygenated blood
   - Irregular heart beats – to supply more blood. Backward failure (backup of blood in body)
   - Oedema - fluid back up in the body
   - Weight gain – due to fluid build up
   - Increased urination – due to more back up of blood

Question 6

How is heart failure diagnosed

Answer 6

· X-ray
To monitor enlarged heart and lungs

Echocardiogram
To monitor ejection fraction, valves and enlargement

Blood test
- Normal <100 pg/ml
- Early heart failure 100-300 pg/ml
- Mild heart failure 300-900 pg/ml
- Severe heart failure >900 pg/m

Question 7

Explain the treatment for heart failure

NOTE : Medical devices are coming in. exam

Answer 7

Early stage treatments

• Regular exercise
• Balanced healthy diet (reduced salt & fat)
• Anti-hypertensive drugs (ACE inhibitors, nitrates & beta-blockers)

Late stage treatments
Anti-hypertensive drugs

• Diuretics – to reduce the congestion in body through removing excessive fluid and reduce blood pressure
• Aldosterone inhibitors – increases the removal of excess sodium & fluid
• Calcium channel blockers – blocks the calcium entry and thus reduce the cardiac activity and blood pressure
• ACE inhibitors, nitrates & beta-blockers

Medical devices

• Ventricular assist device (VAD)
• Directly connected to the affected ventricle and to the output blood vessel via a pump
• Can have for left or right or both
  Used before heart transplantation
• Cardiac resynchronisation therapy
• Pacemaker (connected to affected atria/ventricles and make them beat at the same time with same rate
• Pacemaker with defibrillator – In addition to above, delivers a shock and control the fibrillation

Medical surgery
- Coronary angioplasty
- Heart transplantation