Heart Failure

Question 1

Top 5 causes of HF

Answer 1

IHD
HTN
Valvular heart disease
Cardiomyopathy
Arrhythmias

Question 2

4 pathophysiology points which compensate initially

Answer 2

1. Starling forces causes heart dilation
2. Remodelling (hypertrophy)
3. RAAS activation
4. Sympathetic activation

Question 3

Main causes of HF

Answer 3

1. Pump failure
2. Excessive preload
3. Excessive afterload
4. High-output failure
5. Isolated RHF

Question 4

Pump failure subdivisions

Answer 4

Systolic
Diastolic
Arrhythmic

Question 5

Systolic heart failure causes

Answer 5

IHD
Dilated CM
HTN
Myocarditis
Negatively inotropic drugs

Question 6

Diastolic heart failure causes

Answer 6

HOCM
Pericardial effusion/tamponade
Restrictive pericarditis

Question 7

Arrhythmic causes of heart failure

Answer 7

Heart block
Brady/tachycardia
Anti-arrhythmic drugs

Question 8

Causes of excessive preload

Answer 8

AR
MR
Fluid overload

Question 9

Causes of excessive afterload

Answer 9

AS
HTN
HOCM

Question 10

Causes of high-output failure

Answer 10

Anemia
Pregnancy
Metabolic; hyperthyroidism, Paget’s

Question 11

Causes of isolated RHF

Answer 11

Cor pulmonale
Tricuspid/pulmonary valve dysfunction
Isolated pulmonary HTN

Question 12

HF symptoms

Answer 12

Fatigue
Exertional dyspnoea
PND
Orthopnoea
Nocturnal cough (+ pink frothy sputum)
Weight loss
Muscle wasting

Question 13

Acute vs chronic HF

Answer 13

Acute: pulmonary oedema +.- systemic hypoperfusion
Chronic: evidence of venous congestion

Question 14

Signs of venous congestion

Answer 14

Raised JVP
Smooth, tender hepatomegaly
Pitting/peripheral oedema
Ascites

Question 15

Heart failure criteria

Answer 15

Framingham (2 major or 1 major +2 minor)

Question 16

Investigations

Answer 16

Bloods (FBC, U&E, BNP)
ECG
CXR
Echo

Question 17

What features can be assessed on echocardiography?

Answer 17

Systolic/diastolic function
Areas of hypomotility/dyskinesia
Vegetations
Valve function
Hypertrophy
Intracardiac shunts

Question 18

What level of BNP excludes HF?

Answer 18

<100

Question 19

NHYA classification

Answer 19

1. No limitation of activity
2. Comfy at rest, slight limitation with activity.
3. Marked limitation of ordinary activity.
4. Discomfort + dyspnoea @ rest.

Question 20

1st line management of HF

Answer 20

ACEIs/ARBs
Beta-blockers (start LOW, go SLOW)
Loop diuretics

Question 21

Sacubitril

Answer 21

Neprilysin inhibitor (prevents breakdown of BNP)

Question 22

What is Entresto?

Answer 22

ARNI = angiotension receptor and neprilysin inhibitor

Valsartan + sacubtril

Question 23

How do you reduce CV risk (primary/secondary prevention)?

Answer 23

Stop smoking
Optimise diet and weight loss
Exercise rehab
Reduce salt intake
Aspirin and statins

Question 24

Invasive HF treatment options

Answer 24

Cardiac resynchronisation
ICD
LVAD
Intra-aortic balloon pump
Heart transplant

Question 25

What are the 5 main causes of RVF?

Answer 25

COPD
Left ventricular failure
Volume overload (e.g. tricuspid regurg)
Pressure overload (e.g. PHTN, pulmonary stenosis)
Myocardial disease (e.g. RV MI)