Heart Failure

Question 1

What is the definition of heart failure?

Answer 1

Cardiac output is inadequate for body’s requirements
- impaired LV filling
+/- impaired ejection of blood

Question 2

What is diastolic failure also known as?

Answer 2

HF with preserved ejection fraction

Question 3

Describe the pathophysiology of diastolic failure

Answer 3

Impaired LV filling:
LV doesn’t relax properly in diastole, so volume of blood is reduced
–> reduced SV

Question 4

What is the ejection fraction in diastolic failure?

Answer 4

> 50%

Question 5

What is systolic failure also known as?

Answer 5

HF with reduced ejection fraction

Question 6

Describe the pathophysiology of systolic failure

Answer 6

Impaired ejection of blood:
due to LV wall damage
–> reduced ability to pump/eject blood

Question 7

What is the ejection fraction in systolic failure?

Answer 7

< 40%

Question 8

What are some causes of diastolic failure?

Answer 8

Constrictive pericarditis
Tamponade
Restrictive cardiomyopathy
Hypertension

Question 9

What are some causes of systolic failure?

Answer 9

IHD
MI
Dilated cardiomyopathy

Question 10

Describe some classic symptoms of heart failure?

Answer 10

SOB
Difficulty breathing when lying flat
- orthopnoea
- paroxysmal nocturnal dyspnoea (suddenly waking up SOB/coughing)
Reduced exercise tolerance
Fatigue
Tiredness
Ankle swelling

Question 11

What neck examination finding might be suggestive of fluid overload?

Answer 11

Raised JVP

Question 12

What chest examination findings might suggest fluid overload?

Answer 12

Crackles

Question 13

What might be found on examination of the heart suggestive of fluid overload?

Answer 13

3rd or 4th heart sound (S3 or S4) –> gallop rhythm

Murmur

Question 14

Where might you find oedema in a patient with HF?

Answer 14

Lungs –> left heart failure

Peripheries e.g. sacrum, legs –> right heart failure

Question 15

Which investigations should be done in someone with suspected HF?

Answer 15

ECG
CXR
Echo
BNP

Question 16

What might be seen on an ECG of a patient with HF?

Answer 16

Arrhythmia
Previous MI
LVH

Question 17

What are the classic CXR findings in HF?

Answer 17

A - alveolar bat wings
B - Kerley B lines (interstitial oedema)
C - cardiomegaly (cardiothoracic ratio > 50%)
D - dilated prominent upper lobe vessels
E - effusion (pleural)

Question 18

What is the gold standard investigation for diagnosing HF?

Answer 18

Echocardiogram

Question 19

What is the ejection fraction and what is a normal value?

Answer 19

Percentage of blood pumped out in each beat

Normall >50%

Question 20

What is BNP and why is it useful to test?

Answer 20

Brain natriuretic peptide - cardiac hormone

Can rule out HF in symptomatic patients

Question 21

What are some lifestyle measures in the management of HF?

Answer 21

Exercise based rehab
1.5 - 2 litres water per day
Avoid salt
Vaccinations up to date

Question 22

What are the two main aims of pharmacological management?

Answer 22

Prolong survival

Improve symptoms

Question 23

Which drugs are given to prolong survival in HF?

Answer 23

ACE inhibitors/ARBs
Beta-blockers
Aldosterone antagonists (spironolactone/eplerenone)

Question 24

Which drugs can be given in those who cannot tolerate ACE inhibitors?

Answer 24

Vasodilators

–> Hydralazine + nitrates

Question 25

Which drugs are given to improve symptoms in HF?

Answer 25

Furosemide

Digoxin

Question 26

Which drugs should be stopped/avoided if someone is diagnosed with HF?

Answer 26

Calcium channel blockers