Heart Failure

Question 1

What are the 2 types of Left sided heart failure? Describe.

Answer 1

1. Systolic failure/ Heart failure with reduced ejection fraction (HFrEF): when the left ventricle is not able to pump out blood with enough force into the circulation
2. Diastolic failure/ Heart failure with preserved ejection fraction (HFpEF): when the left ventricles are unable to relax fully/properly in diastole due to stiff heart muscles. The heart cannot be properly fill with blood as a result during diastole.

Question 2

What are the findings in the chest X-ray of patients with left ventricular failure?

Answer 2

ABCDE
A - Alveolar oedema
B - Kerley B lines (interstitial oedema)
C - Cardiomegaly
D - Dilated prominent upper lobe vessels
E - Pleural effusion

Question 3

How is congestive cardiac failure diagnosed?

Answer 3

There is congestive cardiac failure if there is simultaneous presence of at least 2 major criteria or 1 major criterion in conjunction with 2 minor criteria.

Question 4

State the major criteria for congestive cardiac failure based on the Framingham criteria for CCF.

Answer 4

Major criteria:
Paroxysmal Nocturnal Dyspnoea
Crepitations
S3 gallop
Neck vein distension
Acute pulmonary oedema
Hepatojugular reflux
Cardiomegaly (cardiothoracic ratio of >50% on chest radiography)
Increased central venous pressure

Question 5

State the minor criteria for congestive cardiac failure based on the Framingham criteria for CCF.

Answer 5

Minor criteria:
Bilateral ankle oedema
Hepatomegaly
Tachycardia at >120bpm
Pleural effusion
Nocturnal cough
Dyspnoea on normal exertion

Question 6

What is the difference between systolic and diastolic heart failure? Define.

Answer 6

Systolic heart failure is the inability of the heart to pump properly. There is reduced cardiac output. Ejection fraction is <40%. There are signs and symptoms of heart failure AND reduced pumping function.

Diastolic heart failure is the inability of the heart to relax and fill normally, resulting in increased filling pressure. Ejection fraction is >50%. There are signs and symptoms of heart failure but there is normal heart pumping function.

Question 7

What is the commonest cause of right heart failure?

Answer 7

Left heart failure

Question 8

What is a common change in the structure of the heart in chronic heart failure?

Answer 8

There is left ventricular dilatation.

Question 9

What are the initial investigations carried out if heart failure is suspected?
What other investigations are then carried out?

Answer 9

ECG and BNP (B-type natriuretic peptide) levels.
If both ECG and BNP levels are normal, HF is unlikely.
If either is abnormal, do a echocardiography.

Question 10

What is the change in BNP levels in the case of HF?

Under what condition will BNP be released?

Answer 10

BNP levels increase.

BNP is released in large quantities in MI and left ventricular dysfunction.

Question 11

Give an example of an Angiotensin Receptor blocker

Answer 11

Candesartan