Heart failure: ischaemia/valvular/myopathic/hypertensive/cor pulmonae

Question 1

Define heart failure

Answer 1

Heart failure is the inability of cardiac output to meet the physiological demands of the body and can be classified in several ways.

Question 2

Classified heart failuree

Answer 2

1. ) Left ventricular failure (LVF): Symptoms of LVF include nocturnal dyspnoea/wheeze/nocturnal cough with pink sputum caused by pulmonary oedema
2. ) Right ventricular failure: Symptoms of RVF (normally caused by LVF or lung disease) include peripheral oedema and ascites (build up of fluid in abdomen)
3. ) Low output and high output HF: due to excessive afterload/preload or pump failure

Question 3

Describe the epidemiology of heart failure

Answer 3

• More males affected than females

- Older age: 75+

Question 4

Describe the aetiology of heart failure

Answer 4

• Anything causing myocardial damage:
  1. ) CAD
  2. ) Hypertension
  3. ) Atrial fibrillation
  4. ) Valve disease
  5. ) Cardiomyopathies
  6. ) Infective endocarditis
  7. ) Anaemia
  8. ) Endocrine disorders
  9. ) Cor pulmonale: this is right ventricular failure secondary to pulmonary disease

Question 5

What is the pathophysiology of heart failure

Answer 5

• Ejection fraction is less than 40%

Question 6

Describe the signs of heart failure

Answer 6

• Dyspnoea

Question 7

Describe the symptoms of heart failure

Answer 7

• Ascites
• Jugular vein
• Hepatosplegmegaly

Question 8

What are the investigations for heart failure

Answer 8

1.) Bloods: FBC/U&E’s/TFTs/lipid profile/BNP (suggests how much myocytes are being stretched)
2.) CXR: ABCDE
A: alveolar oedema
B: Kerley B lines
C: cardiomegaly
D: dilated upper lobe vessels
E: pleural effusion
3.) ECHO
4.) ECH

Question 9

Describe the differential diagnosis for heart failure

Answer 9

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Question 10

Describe the risk factors for heart failure

Answer 10

1. ) Age: 65+
2. ) Obesity
3. ) Male
4. ) If patient has had previous MI

Question 11

Describe the main classifications for diagnosing HF

Answer 11

1.) Framingham Criteria for Congestive HF:

a.) Major criteria: PAINS
P: parpxysmal noctural dyspnoea
Acute pulmonary oedema
I: increased heart size or increased central venous pressure
N: neck vein dilation
S: S3 gallop

b.) Minor criteria: PAIN
P: pleural effusion
A: ankle oedema
I: increased HR
N: nocturnal cough

2.) NYAC
I: No limitation in physical activity
II: slight limitation of physical activity
III: marked limitation of physical activity
IV: inability to carry out physical activity

Question 12

Describe some complications of heart failure

Answer 12

• Renal failure
• Valve dysfunction
• Stroke

Question 13

Describe treatments for HF

Answer 13

1.) Lifestyle: stop smoking, weight loss, healthy diet and exercise
2.) Medical:
A: ACE inhibitors
B: beta blockers e.g. bisoprolol and carvedilol
C: candesartan (an ARB)
D: digoxin (a cardiac glycoside)
D: diuretics e.g. furosemide
S: spironolactone - an aldosterone receptor antagonist

3.) Surgical: Heart transplantation