Heart failure- investigation and diagnosis

Question 1

Define chronic heart failure

Answer 1

A clinical syndrome comprising of dyspnoea, fatigue or fluid retention because of cardiac dysfunction, either at rest or on exertion, with accompanying neurohormonalactivation

Question 2

What is important to note about heart failure?

Answer 2

-not a final diagnosis - should accompany the underlying structural abnormality and cause - i.e. heart failure due to left ventricular systolic dysfunction (LVSD) due to ischaemic heart disease - heart failure due to severe aortic stenosis

Question 3

What are risk factors for chronic heart failure?

Answer 3

• hypertension - diabetes - increasing age - coronary heart disease

Question 4

How do you diagnosis chronic heart failure?

Answer 4

1. Symptoms and signs + Objective evidence of cardiac dysfunction (and in severe cases response to therapy= diuretics) a) Symptoms: - dyspnoea - fatigue Signs: - oedema - tachycardia - raised JVP - chest crepitations or effusions - Third heart sound - Displaced or abnormal apex beat b) ECHO Radionucleotide scan Cardiac MRI Left ventriculogram ECG(to determine cause) Brain natriuretic peptide is elevated in HF

Question 5

What is an effective test for diagnosing heart failure?

Answer 5

• Brain natriuretic peptide is elevated In heart failure. - Indicates the need for ECHO - But may be elevated due to Valve disease, Atrial fib, elderly

Question 6

What may be the cause of heart failure?

Answer 6

• structural abnormality i.e.: -
  1. left ventricular systolic dysfunction
  2. Valvular heart disease
  3. Pericardial effusion

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