Heart failure – presentation and investigation

Question 1

What is the aetiology of heart failure?

Answer 1

🔹 Ischaemic heart disease (most common)
🔹 Hypertension (chronic pressure overload)
🔹 Valvular heart disease (e.g., rheumatic valve disease)
🔹 Cardiomyopathies (dilated, hypertrophic, restrictive)
🔹 Arrhythmias (AF, ventricular tachycardia)
🔹 Infections (myocarditis)
🔹 Toxins (alcohol, chemotherapy drugs)
🔹 Metabolic disorders (thyroid disease, diabetes)

Question 2

What is the epidemiology of heart failure?

Answer 2

📊 Common condition affecting 1-2% of adults
📈 Prevalence increases with age (>10% in those >70)
🫀 More common in men (due to IHD) but higher mortality in women
💰 Major economic burden due to hospitalizations

Question 3

What is the prognosis of heart failure?

Answer 3

📉 Poor prognosis – 5-year mortality ~50%
🔹 Worse with reduced ejection fraction (HFrEF)
🔹 Frequent hospital admissions increase mortality
🔹 Better with guideline-directed therapy

Question 4

What are the clinical features of heart failure?

Answer 4

🩸 Left-sided heart failure:
➡️ Pulmonary congestion (dyspnea, orthopnea, PND)
➡️ Fatigue, weakness
➡️ Nocturnal cough, wheezing

💙 Right-sided heart failure:
➡️ Peripheral oedema (ankle swelling)
➡️ Hepatosplenomegaly, ascites
➡️ Jugular venous distension (JVP raised)

Question 5

What are the key investigations for heart failure?

Answer 5

🩺 Bedside:

ECG (LV hypertrophy, AF, Q waves)
BNP (B-type natriuretic peptide) – Raised in heart failure
📡 Imaging:

Echocardiography – Gold standard for EF measurement
CXR – Pulmonary congestion, cardiomegaly
🔬 Blood tests:

FBC (anaemia)
U&E (renal dysfunction)
LFTs (hepatic congestion)

Question 6

What are the treatment options for heart failure?

Answer 6

💊 First-line pharmacological treatment
✅ ACE inhibitors (e.g., Ramipril) – Reduce afterload
✅ Beta-blockers (e.g., Bisoprolol) – Improve survival
✅ Diuretics (e.g., Furosemide) – Symptom relief (fluid overload)
✅ Mineralocorticoid receptor antagonists (e.g., Spironolactone) – Mortality benefit

💉 Advanced therapies:
🩸 Ivabradine – Reduces HR in HFrEF
🔌 Devices (ICD, CRT-P, CRT-D) for severe cases
🫀 Heart transplant (last resort)

Question 7

What is the evidence for heart failure treatment?

Answer 7

📌 ACE inhibitors & Beta-blockers – PROVEN mortality benefit (CONSENSUS, SOLVD trials)
📌 Spironolactone – RALES trial showed 30% mortality reduction
📌 Diuretics – Improve symptoms but no mortality benefit

Question 8

Mnemonic for Heart Failure Treatment:

Answer 8

💊 “ABCD” for CHF Treatment
A – ACE inhibitors / ARBs
B – Beta-blockers
C – Cardiac resynchronization therapy (CRT)
D – Diuretics (for symptom relief)