heart failure

Question 1

what is heart failure?

Answer 1

severe failure of the heart to function properly, especially as a cause of death.

Question 2

what is the most common cause of heart failure?

Answer 2

myocardial dysfunction

Question 3

what are the other causes of heart failure? ( Aetiology )

Answer 3

• Hypertension,
• alcohol excess,
• cardiomyopathy,
• valvular,
• endocardial,
• pericardial causes.

Question 4

what tests are done to confirm diagnosis?

Answer 4

-History and physical examination
-CXR/ blood tests
-ECG
-Echocardiography
-Myocardial perfusion imaging

Question 5

what symptoms are involved in the protection of survival and in the production of the heart failure syndrome:

Answer 5

1. The sympathetic system
2. The renin-angiotensin-aldosterone axis
3. Inflammation

Question 6

what are the three cardinal symptoms of heart failure that are non specific?

Answer 6

1. shortness of breath
2. fatigue
3. ankle swelling

Question 7

what is class I using the New York Heart association (NYHA) classification?

Answer 7

no limitation (asymptomatic)

Question 8

what is class II using the New York Heart association (NYHA) classification?

Answer 8

slight limitation (mild HF)

Question 9

what is class III using the New York Heart association (NYHA) classification?

Answer 9

marked limitation (moderate HF)

Question 10

what is class IV using the New York Heart association (NYHA) classification?

Answer 10

inability to carry out any physical activity without discomfort (severe HF)

Question 11

What are the 4 heart failure stages?

Answer 11

A. High risk for developing HF
B. Asymptomatic HF
C. Symptomatic HF
D. End-stage HF

Question 12

What are the causes of acute decompensation of chronic heart failure?

Answer 12

-AMI
-Uncorrected increased -blood pressure
-Obesity
-AF and arrhythmias
-Excess alcohol
-Endocrine
-NSAIDs

Question 13

what are the possible complications of heart failure?

Answer 13

-Renal dysfunction
-Rhythm disturbances
-Systemic thromboembolism
-DVT and PE’s
-LBBB and bradycardia
-Hepatic dysfunction
-Neurological and psychological complications

Question 14

what medications would you give and what is their impact? - diuretics

Answer 14

-impact is mainly symptomatic relief of oedema and dyspnoea
-Thiazides
-Loop diuretics

Question 15

what medications would you give and what is their impact? - ACEi

Answer 15

reduce morbidity and mortality of HF patients

Question 16

what medications would you give and what is their impact? - aldosterone antagonism

Answer 16

reduction of morbidity and mortality of HF patients

Question 17

what medications would you give and what is their impact? - Beta blockers

Answer 17

reduce morbidity and mortality, should be started early

Question 18

what medications would you give and what is their impact? - ARBs

Answer 18

used if the patient has had adverse side effects to ACEi

Question 19

what medications would you give and what is their impact? - Hydralazine and Nitrates

Answer 19

arterial and venous dilators

Question 20

what medications would you give and what is their impact? - digoxin

Answer 20

decreases risk of death attributed to worsening HF

Question 21

what surgeries are done for heart failure? ( 4)

Answer 21

-Mitral valve repair
-Aortic valve replacement
-Mitral valve replacement
-Left ventricular re-modelling

Question 22

what does multi-site pacing achieve?

Answer 22

re-synchronisation of the failing heart (CRT)

Question 23

what is the effect of multi site pacing ?

Answer 23

This improves symptoms and could reduce mortality

Question 24

what does adding a defibrillator to multi site pacing do?

Answer 24

reduces arrhythmic mortality

Question 25

what are the cardio myopathies?

Answer 25

Dilated
Hypertrophic
Restrictive
Right ventricular