Heart Failure

Question 1

HEART FAILURE
Definition:

Answer 1

Inability of the heart to pump blood sufficient enough to meet the metabolic demands of the body. There is usually an imbalance between the oxygen demands and the oxygen supply due to reduced cardiac output.

Question 2

TYPES OF HEART FAILURE

Answer 2

Systolic and diastolic

Question 3

SYTOLIC: -

Answer 3

SYTOLIC: - this is a dysfunction of the heart contractility, causing a reduction in the ejection
fraction of <40%. It affects the contractility of ventricles and accounts for 70% of the cases.

Question 4

DIASTOLIC: -

Answer 4

DIASTOLIC: - There is an impairment in the filling pressure. Basically the heart is unable to
relax enough to allow filling of blood. The ejection fraction is usually >40%.

Question 5

NHA CLASSIFICATION OF HF

Answer 5

I. Stage one- No limitation of physical activities and is asymptomatic.

II. Stage two- minimal symptoms and slight limitation to physical activities.

III. Stage three – there is marked limitation of activities and symptoms

IV. Stage four- is the end stage; no physical activities can be tolerated and symptoms are seen
at rest.

Question 6

CAUSES

Answer 6

I. Ischemic Heart Disease (62%)
II. Cigarette smoking (16%)
III. Hypertension (10%)
IV. Drugs (e.g chemotherapeutic drugs)
V. Kidney disease
VI. Coronary Heart Diseases (2%)

Question 7

RISK FACTORS

Answer 7

 Race (Black people)
 Alcohol
 Age (>65 in whites and >50yrs in Africans)
 Obesity
 Gender (common in males than in women)
 Smoking (16%)
 Diabetes mellitus (3%) and HTN
 Myocardial Infarction

Question 8

SIGNS AND SYMPTOMS

Answer 8

a) Dyspnea
b) Distention of neck veins
c) Fatigue, weakness
d) Ascites
e) Cyanosis
f) Anaemia
g) Tachycardia/ palpitations
h) Edema

Question 9

DIAGNOSIS

Answer 9

Physical History
ECO, ECO, FBC/DC
Lipid profile, endocrine disorders Kidney function
Chest X-ray
Thyroid function test

Question 10

NON-PHARMACOLOGICAL MANAGEMENT

Answer 10

Diet Restrictions- reduce salt intake to 2.4g/day of pure salt and 6g/day compound salt -Exercises
-Weight loss- at least BMI of 18.5-24.5
-Fluid restriction
-Avoid NSAIDS
-Smoke cessation
-Reduce alcohol intake

Question 11

pharmacology management

Answer 11

1. ACEI + Beta Blocker
2. ACEI + Beta Blocker + ARB
3. ACEI + Beta Blocker + spironolactone
4. ACEI + Beta Blocker + isosorbide dinitrate + hydralazine
5. Isosorbide dinitrate + hydralazine ( if ACEI or ARB are not tolerated)
6. Digoxin ( reserved if above treatment fails)