Heart failure

Question 1

What is heart failure?

Answer 1

Failure of the heart to pump enough blood to meet the demands of the body (pump failure)

Question 2

Describe the clinical presentation of heart failure

Answer 2

Heart failure may present as predominantly left-sided, right-sided or both

Left-sided HF:

• Blood backs up in the lungs, resulting in pulmonary oedema
• Symptoms/signs: dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, fatigue

Right-sided HF:

• Blood backs up in systemic venous circulation, resulting in systemic oedema
• Symptoms/signs: pedal/sacral oedema, hepatosplenomegaly, ascites

Question 3

Describe the investigation of heart failure

Answer 3

• Bloods: FBC, U&E, LFT, BnP
• ECG
• CXR
• Echocardiography

Question 4

Describe the signs you may see on CXR in a patient with heart failure

Answer 4

ABCDE

A - Alveolar oedema
B - Kerley B lines
C - Cardiomegaly
D - Dilated pulmonary vessels
E - pleural Effusion

Question 5

Which drugs are used in the management of chronic heart failure?

Answer 5

NICE guidelines:

1. Loop diuretic, e.g. Furosemide (fluid overload)
2. ACE inhibitor, e.g. Ramipril (or ARB if ACEi is not tolerated or is contraindicated)
3. Beta-blocker, e.g. Bisoprolol

If patient is still symptomatic, refer to cardiology

Question 6

What is the name of the system used to classify heart failure

Describe this classification

Answer 6

New York Heart Association classification

• Class I: no limitation, normal physical activity does not produce symptoms of HF (fatigue, dyspnoea, palpitations)
• Class II: mild limitation, normal physical activity produces symptoms of HF (fatigue, dyspnoea, palpitations)
• Class III: marked limitation, gentle physical activity produces symptoms of HF (fatigue, dyspnoea, palpitations)
• Class IV: symptoms of heart failure at rest