Heart failure diagnosis 2.0

Question 1

What investigations can you carry out for heart failure?

Answer 1

ECG
Echocardiogram
Blood test
Chest x-ray

Question 2

What might yo see on a chest x-ray of someone with heart failure?

Answer 2

A: Alveolar oedema (with ‘batwing’ perihilar shadowing)
B: Kerley B lines (caused by interstitial oedema)
C: Cardiomegaly (cardiothoracic ratio >0.5)
D: upper lobe blood diversion
E: Pleural effusions (typically bilateral transudates)
F: Fluid in the horizontal fissure

Question 3

What is the main thing to look for in the blood that would suggest heart failure?

Answer 3

BPN (B-type natriuretic peptide )

Question 4

If BPN is raised, what should the patient be referred for?

Answer 4

Trans-thoracic echocardiogram

Question 5

What is the next step if that patients BNP is >2000ng/L?

Answer 5

Urgent 2 week referral for specialist assessment and an ECHO.

Question 6

What is the next step if the patients BNP is 400-2000ng/L?

Answer 6

6 week referral for specialist assessment and an ECHO.

Question 7

What is the purpose of an ECHO?

Answer 7

It will will confirm the presence and degree of ventricular dysfunction.

Question 8

How is ventricular dysfunction measured?

Answer 8

It is measured by the ejection fraction

Question 9

What does an ejection fraction of less than 40% suggest?

Answer 9

Heart failure is reduced ejection fraction

Question 10

What does an ejection fraction of greater than 40% but raised BNP suggest?

Answer 10

Heart failure with preserved ejection fraction

Question 11

What classification system is used to classify severity of cardiovascular disability?

Answer 11

New York Heart Association Classification of Heart failure

Question 12

How does the New York Heart Association Classification of Heart failure rate severity of the disease?

Answer 12

The severity of exertional dyspnoea limiting activity, or discomfort at rest.

Question 13

What does the classification run from?

Answer 13

Class I- no limitation
to
Class IV- discomfort at rest

Question 14

What is class 1 of the NYHA classification?

Answer 14

No limitation in physical activity, and activity does not cause undue fatigue, palpitation or dyspnoea.

Question 15

What is class 2 of the NYHA classification?

Answer 15

Slight limitation of physical activity, and comfort at rest. Ordinary physical activity causes fatigue, palpitation and/or dyspnoea.

Question 16

What is class 3 of the NYHA classification?

Answer 16

Marked limitation in physical activity, but comfort at rest. Minimal physical activity causes fatigue (less than ordinary).

Question 17

What is class 4 of the NYHA classification?

Answer 17

Inability to carry on any physical activity without discomfort, with symptoms occurring at rest
If any activity takes place, discomfort increases.