Heart Failure

Question 1

Definition of heart failure

Answer 1

The state in which the heart is unable to pump blood at a rate commensurate with the requirements of the tissues or can do so only at high pressures

Question 2

Causes of heart failure

Answer 2

Impairment of left ventricular filling, impaired ejection of blood

Question 3

Aetiology for heart failure

Answer 3

Coronary heart disease, hypertension, diabetes, dilated cardiomyopathy, valve disease (aortic stenosis most common), tachycardic arrhythmias

Question 4

Classic symptoms of heart failure

Answer 4

SOB, orthopnoea, paroxysmal nocturnal dyspnoea, reduced exercise tolerance, fatigue, tiredness, ankle swelling

Question 5

Clinical findings in heart failure

Answer 5

Elevated JVP, rales or crackles on auscultation of the lungs, gallop rhythm and/or murmur on auscultation of the heart, oedema in sacrum/feet/ankles/lower legs

Question 6

Most useful diagnostic test for heart failure

Answer 6

Echocardiography

Question 7

What do echocardiograms reveal?

Answer 7

Chamber size, function of ventricles, evidence of MI, evidence of impaired LV filling, valvular disease, diseases of the pericardium, ejection fraction

Question 8

Ejection fraction

Answer 8

The volume of blood pumped by the heart during each beat

Question 9

Normal value for ejection fraction

Answer 9

> 50%

Question 10

Heart failure with reduced ejection fraction - value

Answer 10

<40%

Question 11

What happens in heart failure with reduced ejection fraction?

Answer 11

The left ventricle is unable to eject an adequate amount of blood during systole

Question 12

What happens in heart failure with preserved ejection fraction?

Answer 12

Less blood is able to fill the LV in diastole, due to myocardial stiffness and this the LV has less blood to eject during systole

Question 13

Cardiac hormones

Answer 13

BNP - ventricular hormone, and ANP - atrial hormone

Question 14

What hormone do you use to rule out heart failure in symptomatic patients?

Answer 14

BNP - if it is elevated then heart disease is likely

Question 15

Normal BNP value

Answer 15

<150

Question 16

Diagnostic tests for heart failure

Answer 16

BNP, NP-proBNP, ECG (normal or exercise), CXR, 2-D echocardiogram with doppler (GOLD STANDARD), angiogram/CT coronary angiogram, MRI

Question 17

Lifestyle modifications in the treatment of heart failure

Answer 17

Exercise therapy, water and salt restriction, keep vaccinations up to date, manage mental health

Question 18

Drugs that prolong survival in heart failure

Answer 18

ACE inhibitors/ARBs, beta blockers, aldosterone antagonists (spironolactone), vasodilators, ivabradine

Question 19

Drugs that improve symptoms in heart failure

Answer 19

Digoxin, furosemide

Question 20

First line treatment for left ventricular systolic dysfunction

Answer 20

ACE inhibitors AND beta-blockers

Question 21

Benefit of cardiac resynchronisation therapy in heart failure

Answer 21

Increases synchronous contraction and improves left ventricle haemodynamics

Question 22

LVAD potential candidates

Answer 22

Not currently treatment eligible, no end stage kidney disease, liver disease or lung disease, life expectancy <2 years without LVAD

Question 23

Heart transplant indications

Answer 23

Refractory cardiogenic shock, documented dependence on IV inotropic support to maintain adequate organ perfusion, peak VO2 <10ml/kg/min, severe symptoms of ischaemia not amenable to revascularisations, recurrent symptomatic ventricular arrhythmias refractory to all therapeutic modalities

Question 24

Contraindications for heart transplant

Answer 24

Age, severe co-morbidity

Question 25

SGLT2 inhibition - new drug:

- What does it do?

Answer 25

Lowers blood glucose levels, lowers BP, increases urinary caloric loss with reductions in body weight, reduces albuminuria