Heart Failure

Question 1

Heart failure: Definition

Answer 1

• A complex syndrome, rather than diagnosis/ disease in itself
• Resulting from a range of structural or functional cardiac disorders that impairs the ability for the heart to function as a pump to support physiological circulation
• HF-REF (red ejection fraction) (LV systolic impairmnent w/ LVEF <40%)
• HF-PEF (preserved EF) (LVEF >50% with dialated LA)
• HF-PH (pulmonary hypertension)
• HF-valve (valve disease) (severe stenosis/ regurgitation)

Question 2

Heart failure: Aetiology

Answer 2

• ischaemia
• cardiomyopathy
• hypertension
• valvular heart disease
• cor pulmonale (aka R sided heart failure, linked to resp issues)

Question 3

Heart failure: Risk factors

Answer 3

• Age
• Male sex
• Tobacco smoke
• High blood cholesterol
• High blood pressure
• Physical inactivity
• Obesity and being overweight.

Question 4

Heart failure: Pathophysiology

Answer 4

• Depends on aetiology
• ischaemia
  
  • various CADs, atherosclerosis
• cardiomyopathy
  
  • genetic, stress related, trauma
• hypertension
  
  • genetic, diet, vascular health
• valvular heart disease
  
  • conjenital, age
• cor pulmonale (aka R sided heart failure, linked to resp issues)
  
  • PH > changes in the small blood vessels inside the lungs

Question 5

Heat failure: Cinical manifestations: key presentations, other symptoms and signs

Answer 5

• paroxmal nocturnal dyspnoea
• orthopnea
• SOB
• fatigue
• ankle oedema
• cold peripheries (inadequate perfusion)
• displaced apex beat
• raised JVP (jugular venous pressure)
• added heart sounds and murmurs
• ascites

Question 6

Heart falure: Investigations (diagnosis): 1st line, gold standard & other

Answer 6

• depends on suspeced aetiology
• BNP or NTpro-BNP levels (higher indicates HF)
• transthoratic ECHO
• ECG unlikely to be normal and can detect aetiology such as MI or arrythmia

Question 7

Heart failure: DDx

Answer 7

• each kind of HF can be mistaken for other kinds
• as HF isn’t really a full diagnosis in it’s self and rather a symptom of a specific issue, it’s DDx is expansive

Question 8

Heart failure: Management

Answer 8

• Does depend on specific aetiology of HF
• However there are some pretty broad spectrum treatments which a lot of patients will recieve
  
  • ACE inhibitor
    
    • ARB (angiotensin receptor blocker) for containdications
  • Beta-blocker
  • diuretics eg furosemide
  • mineralcorticoid receptor antagonist
• others
  
  • cardiac resynchronisation therapy
  • implantable defibrillator
  • LV assist device
  • H transplant