heart failure

Question 1

what is 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

what causes heart failure

Answer 2

heart failure is not a final diagnosis and the term should be qualified by the underlying structural abnormality and cause​

- heart failure due to LVSD due to IHD​

- heart failure due to severe aortic stenosis​

Question 3

epidemiology

Answer 3

increases with age

Question 4

factors that increase risk of heart failure

Answer 4

myocardial infarction
aging population
hypertension
coronary heart disease
disease
HLP
obesity

Question 5

prognosis of heart failure

Answer 5

less than a year survival rate

Question 6

symptoms of heart failure

Answer 6

oedema
bilateral crepitation
breathlessness
fatigue
reduced exercise capacity

Question 7

signs of heart failure

Answer 7

oedema
raised jvp
chest crepitation and effusion
displaced or abnormal apex beat
3rd heart sound
tachycardia

Question 8

making a diagnosis for heart failure

Answer 8

signs and symptoms are improved by rest or exercise
there is response to therapy especially diuretics

Question 9

screening for cardiac dysfunction

Answer 9

echocardiogram
mri
left ventriculography

Question 10

normal ecg

Answer 10

excludes left ventricular failure

Question 11

high bnp

Answer 11

elevated in patients with heart failure

Question 12

what are the primary causes of heart failure ?

Answer 12

LV systolic dysfunction – many causes​

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 13

what are causes of left ventricular dysfunction

Answer 13

ischemic heart disease
dilated cardiomyopathy which is not because of ihd or secondary to other lesion like valve disease
valve disease or mitral regurgitation

Question 14

importance of doing an echocardiogram

Answer 14

will identify and quantify
-lv systolic dysfunction
-valvular dysfunction
-pericardial effusion
-diastolic dysfunction
-atrio/ventricular shunts
-pulmonary hypertension

Question 15

what is the normal ejection fraction

Answer 15

55%

Question 16

what can cause a decrease in the left ventricle ejection fraction?

Answer 16

Disease / physiological changes can both decrease and increase the LVEF​

The LVEF may be lower than previous but not pathologically low ​

Analagous to Haemoglobin / anaemia​

eg. fall in Hb from 17g/dL to 14.5g/dL​

Question 17

left function assessment and lvef

Answer 17

normal 55-70%
mild 40-55%
moderate 30-40%
severe less than 30

Question 18

biplane and simpsons rule of calculating left ventricle size

Answer 18

divide left ventricle into different slices of different thickness and diameter

Question 19

disadvantages of Simpson`s rule

Answer 19

the endocardial border can fail to not be traced accurately

Question 20

MUGA scan for lvef

Answer 20

greater reproducibility and there is use of ionising radiation

Question 21

cardiac MRI

Answer 21

more accurate than echo- cardiogram

Question 22

grading severity of heart failure

Answer 22

degree of left ventricle failure
degree of elevation of BNP
NYHA class that is the severity of symptoms.