Heart Failure

Question 1

What is the typical symptom of heart failure ?

Answer 1

Breathlessness

Question 2

What is congestive heart failure ?

Answer 2

Heart failure due to congestion in tissues away from the heart

Question 3

What is likely if you have left sided heart failure ?

Answer 3

Right sided heart failure

Question 4

What is likely if you have right sided heart failure ?

Answer 4

Left sided heart failure

Question 5

Heart failure is assessed using what measurement?

Answer 5

Left ventricular ejection fraction

Question 6

Heart failure with preserved Left Ventricular Ejection Fraction (LVEF)

Answer 6

Diastolic heart failure

Question 7

Heart failure with reduced LVEF

Answer 7

Systolic heart failure

Question 8

Normal ejection fraction is

Answer 8

More than 50 %

Question 9

The value of Reduced LVEF is …

Answer 9

Less than 40%

Question 10

What is the formula for ejection fraction

Answer 10

Stroke volume / end diastolic volume

Question 11

Which is the preferred terminology:

Preserved/ reduced LVEF
Or
Systolic / diastolic heart failure

Answer 11

Preserved/ reduced LVEF

Question 12

What is Class I Heart failure ?

Answer 12

No limitation, normal physical exercise does not cause fatigue

Question 13

What is Class III heart failure ?

Answer 13

Marked limitation, comfortable at rest but gentle physical activity causes marked symptoms of heart failure

Question 14

What is class II heart failure

Answer 14

Mild limitation. Comfortable at rest but normal physical activity causes symptoms

Question 15

Class IV heart failure is

Answer 15

Symptoms of heart failure occur at rest and are made worse with physical activity

Question 16

What is the most common cause of Heart Failure

Answer 16

IHD

Question 17

why does the heart increasing in size not help in heart failure

Answer 17

Accompanied with deposition of fibrous tissue in the form of interstitial fibrosis. Due to mismatch of supply and demand of nutrients in the Heart, the hypertrophied heart is vulnerable to ischaemic related decompensation

Also heart remodelling

Impairment of endothelium dependent vasodilation in peripheral blood vessels, the effect of nitric oxide is blunted

Circulatory levels of endothelium are increased, many functions that contribute to pathophysiology of heart

Question 18

What happens to the Renin-angiotensin aldosterone system in heart failure

Answer 18

Reduced cardiac output leads to a decrease in renal perfusion and the RAA system is activated.

Enhanced salt and water retention.
This further increases venous pressure

Question 19

How is the sympathetic system effected in heart failure

Answer 19

Reduction in stroke volume means increase heart rate.

Chronic sympathetic activation has deleterious effects (e.g myocyte apoptosis)

This explains why beta blockers can be used in cardiac failure .

Question 20

What is the role of natriuretic peptides in heart failure

Answer 20

They act as a counter regulatory system for the RAAS

Cause Decrease in blood volume, arterial pressure, central genius pressure and cardiac output

Can use measurement of plasma natriuretic in the workup of suspected heart failure

Question 21

What are the features of left sided heart failure

Answer 21

pooling of blood in the pulmonary circulation

Pulmonary congestion and oedema

Pleural effusions (cause starboard, Orthopnea and paroxysmal nocturnal dyspnoea) 
—

Inadequate perfusion downstream tissues
E.g renal and cerebral hypoperfusion

Hemosiderin laden macrophages in alveolar spaces May be found which arise due to haemorrhage

Dilation if left atrium leading to atrial fibrillation and increasing risk of stroke

Question 22

What are the causes and features of right sided heart failure

Also what is the name if there’s isolate right heart failure

Answer 22

Causes : pulmonary hypertension
Right ventricular infarction
Right ventricular cardiomyopathy
Adult congenital heart disease

Features:

If isolated known as cor pulmonale

Congestion of liver and portal system, can lead to congestive hepatomegaly => nutmeg liver

Hepatic necrosis can occur (especially with left side failure)

Portal genius hypertension can lead to enlargement of spleen
Chronic congestion and oedema in bowel was
Fluid accumulation Pleural, pericardial and peritoneal spaces

Oedema of the peripheral and dependent portions of the body especially ankle and Pretibial oedema hall mark of right sided failure

Anasarcs = massive oedema May occur