Heart Failure

Question 1

What is the 5 year prognosis?

Answer 1

50% of people die within 5 years of diagnosis

Question 2

What is HF-PEF & how common?

Answer 2

Heart failure with preserved ejection fraction

<50% of patients with HF

Question 3

What are indicators of poor prognosis in HF?

Answer 3

Increased age, reduced EF, raised JVP, smoking, obesity

Question 4

What are the 3 most common causes of HF (think cardiac)

Answer 4

CORONARY ARTERY DISEASE
Hypertension
Cardiomyopathy

Question 5

What high-output states can cause HF?

Answer 5

Anaemia
Thryrotoxicosis
Septicaemia
Liver failure

Question 6

What drugs can contribute to HF?

Answer 6

NSAIDs, Beta blockers, CCB, cocaine

Question 7

What is the pathophysiology of left-sided HF?

think RAAS, blood flow to the kidneys

Answer 7

Damage to the myocardium

1. Reduced blood flow to the kidneys
2. Activates RAAS, leading to fluid retention
3. Increased filling & pre-load, which increases filling & pre-load & increases contraction strength (frank-starling model)
4. Causes fluid to build up in the lungs

Question 8

What is the frank-starling model?

Answer 8

Inc volume = inc contraction

Question 9

What causes right-sided HF?

Answer 9

Left sided HF/ chronic lung disease (cor pulmonale)

Question 10

What is the pathophysiology of right sided HF?

Answer 10

Inc pressure in the pulmonary artery makes it harder for the RV to pump
This leads to right-sided hypertrophy

Question 11

What investigations are needed in suspected HF?

Answer 11

BNP
ECG
Bloods: FBC, TFT, HbA1c, eGFR, Us&Es
Urine Dip

Question 12

What are other causes of raised BNP?

Answer 12

Age >70
CKD
Diabetes
MI

Question 13

What is the gold-standard for diagnosis of HF?

What would it show?

Answer 13

Echocardiogram
LVF
Systolic dysfunction

Question 14

What is a raised BNP?

Answer 14

> 400

Question 15

If BNP is >2000 what should you do?

Answer 15

Urgent referral to specialist (echocardiography within 2 weeks)

Question 16

If patient is symptomatic, what drug would you give?

Answer 16

Loop diuretic (e.g. furosemide)

Question 17

What is the summary of HF treatment?

Answer 17

loop diuretic + ACEi (if diabetic) + B blocker (if angina)

Question 18

When should you start someone on an ACEi before a BB?

Answer 18

If the person has diabetes or signs of fluid overload

Question 19

When should ACEi be avoided?

Answer 19

Valvular disease

Question 20

When should someone be started on a BB over ACEi?

Answer 20

If they have angina

Question 21

Should they start on a high dose of ACEi/ BB?

Answer 21

NO - start low, go slow

Question 22

What can be added if HF is still not controlled?

Answer 22

Spironalactone (aldosterone antagonist)

Question 23

What can be given if ACEi not tolerated?

Answer 23

ARB (e.g. losartan)

Question 24

When is spironalactone contraindicated?

Answer 24

Severe renal impairment
Hyperkalaemia
Addison’s