Heart Failure

Question 1

What is heart failure?

Answer 1

Failure of the heart to maintain normal circulation and meet the needs of the body.

Question 2

How is HF sub-divided?

Answer 2

• HFrEF

- HFpEF

Question 3

What ejection fraction decides if it is HFpEF or HFrEF?

Answer 3

40%

HFrEF is <40%

HFpEF is 40+%

Question 4

What are the three top causes of HF?

Answer 4

• MI (death of cardiac muscle)
• HTN (increased afterload)
• Dilated cardiomyopathy

Question 5

What are some other causes of HF?

Answer 5

• Cor pulmonale
• Arrythmias
• Congenital heart defects
• Chemotherapy

Question 6

How might HF present?

Answer 6

• Dyspnoea
• Othopnoea
• PND
• Cough- frothy white/pink sputum
• Peripheral oedema

Question 7

What signs might you see on examination?

Answer 7

• Raised JVP
• Tachycardia
• Bi-basal crackles
• 3rd and 4th heart sounds
• Oedema

Question 8

What blood test is important for HF?

Answer 8

BNP (B-type natriuretic peptides)

• Released from ventricles when overstretched
• Relaxes SM to reduced systemic vascular resistance
• Rules out if negative but not specific to HF

Question 9

What other bloods are useful in HF?

Answer 9

• C peptide
• ADH (increased)
• Hyperthyroid

Question 10

What might a CXR show?

Answer 10

Alveolar shadowing (batwing)
Kerley B lines
Cardiomegaly
Distribution of vessels to the apices
Effusion

Question 11

What test is definitive for HF?

Answer 11

ECHO

Question 12

What else can raise BNP?

Answer 12

• Sepsis
• PE
• Renal impairment
• COPD

Question 13

Which classification is used for HF symptoms?

Answer 13

NYHA Classification

Question 14

Outline the NYHA Classification.

Answer 14

1 No limitation of activity

2 Mild limitation, comfortable at rest, symptoms w. normal exertion

3 Marked limitation comf. at rest, limitation of gentle exercise

4 Breathless at rest

Question 15

What scale is used for dyspnoea?

Answer 15

MRC scale

Question 16

Outline the MRC scale.

Answer 16

1 Strenuous exercise
2 Hurrying on level or steep hill
3 Slower on the level may have to stop
4 Stops every 100m or few minutes
5 Housebound

Question 17

What lifestyle advice is given in HF?

Answer 17

• Smoking cessation
• Salt and fluid restriction
• Exercise as tolerated
• No HGV driving

Question 18

What conservative medical management is there?

Answer 18

• Annual flu vaccine
• 5 yearly pneumococcal vaccine
• HF specialist nurse

Question 19

Outline the medical management of HF.

Answer 19

1 Treat underlying cause
2 ACEi/ARB or Beta-Blocker (titrate up or give both)
3 Aldosterone antagonist (Spironoloactone)
4 Digoxin or resynch therapy (CRT)
5 Loop diuretic

Question 20

What surgical management will be of benefit?

Answer 20

Correction of valve deformities

Question 21

What complications are there in HF?

Answer 21

ABCDE

• Arrhythmias
• Blood (anaemia)
• Chronic renal insufficiency
• Death
• Effusion/oEdema