Heart Failure

Question 1

What percentage of patients dies within 5 years of diagnosis

Answer 1

25-50%

Question 2

Prevalence in general population is?

Answer 2

1-3%

Question 3

Prevalence in the elderly?

Answer 3

~10%

Question 4

What is systolic failure?

Answer 4

Inability of the ventricle to contract properly resulting in reduced CO and a EF of less than 40%

Question 5

What are the common causes of systolic failure?

Answer 5

IHD, MI, Cardiomyopathy

Question 6

What is diastolic failure?

Answer 6

Inability of the ventricle to relax properly resulting in increased filling pressures and an EF of greater than 50%

Question 7

Causes of diastolic failure?

Answer 7

Cardiac tamponade, restrictive cardiomyopathy, constrictive pericarditis, hypertension

Question 8

Systolic and diastolic failure are mutually exclusive, true or false?

Answer 8

False, they normally co-exist

Question 9

When left ventricular and right ventricular failure co-exist, it is known as what?

Answer 9

Congestive cardiac failure

Question 10

What are the symptoms of left sided heart failure?

Answer 10

Dyspnoea, poor exercise tolerance, fatigue, orthopnoea, paroxysmal nocturnal dyspnoea, nocturnal cough (may have pink frothy sputum), wheeze, nocturia, cold peripheries, weight loss and muscle wasting

Question 11

Symptoms of right sided failure include?

Answer 11

Peripheral oedema, ascites, nausea, anorexia, facial engorgement, elevated JVP, pulsation on neck and face

Question 12

Causes of right sided heart failure include?

Answer 12

Pulmonary stenosis, lung disease and LVF

Question 13

What does acute heart failure refer to?

Answer 13

New onset or sudden de compensation of chronic heart failure leading to pulmonary/peripheral oedema with or without peripheral hypoperfusion

Question 14

How is venous return effected compared to arterial pressure in chronic heart failure?

Answer 14

Arterial pressure is maintained until very late whereas venous congestion occurs much earlier

Question 15

What is low output failure?

Answer 15

Low CO which fails to increase normally upon increased exertion

Question 16

What are the three main mechanisms of failure in low output heart failure?

Answer 16

Pump failure, excessive preload and chronic excessive afterload

Question 17

Give to causes of pump failure

Answer 17

Systolic/diastolic heart failure and decrease in heart rate due to drugs, MI or heartblock

Question 18

Give to causes of excessive preload

Answer 18

Fluid overload and mitral regurgitation

Question 19

Give to causes of excessive afterload

Answer 19

Aortic stenosis or hypertension

Question 20

What is high output failure?

Answer 20

Abnormally high demand from the body means that the normal/increased CO is not sufficient

Question 21

Causes of high output failure?

Answer 21

Anaemia, thyrotoxicosis, pregnancy and Paget’s disease

Question 22

In high output failure, which side fails first?

Answer 22

The right side of the heart

Question 23

What criteria system is used to diagnose HF?

Answer 23

Framingham criteria

Question 24

How many of the Framingham criteria must be met?

Answer 24

2 major or 1 major and two minor

Question 25

Name 5 of the major criteria from the Framingham criteria

Answer 25

Crepitations, S3 gallop, cardiomegaly, increased CVP, Raised JVP

Question 26

What are the two main investigations?

Answer 26

ECG and B type naturetic peptide

Question 27

BNP level indicates what?

Answer 27

Myocardial stretch

Question 28

How sensitive is BNP testing?

Answer 28

> 90%

Question 29

If either of the two main tests are abonormal, what is the next test?

Answer 29

Echocardiogram (this is the key test for HF and may reveal the cause)

Question 30

What is the definition of heart failure?

Answer 30

When the cardiac output does not meet the requirements of the body’s demands.