Heart failure - Presentation and Investigation

Question 1

Define Heart Failure

Answer 1

A clinical syndrome comprimising of dysponea, fatigue or fluid retention due to cardiac dysnfunction, either at rest or on exertion with accompanying neurohormonal activation.
Heart failure is not a final diagnosis. It should be qualified by the underlying structural abnormality and cause e.g heart fialure due to LSVD due to IHD OR heart failure due to aortic stenosis.

Question 2

What are the symptoms and signs of heart failure?

Answer 2

Symptoms inlcude breathlessness, fatigue, oedema and reduced exercise capacity.
Signs include oedema, tachycardia, raised JVP, chest creptions or effusion, 3rd heart sounds and displaced or abnormal apex beat.

Question 3

How is diagnosis made of heart failure?

Answer 3

• Check symptoms or signs of heart fialure (at rest and during exericse)
• Objective evidence of cardiac dysnfunction and in doubt…
• …Refer to therapy

Question 4

What investigations can be carried out for heart failure?

Answer 4

Echocardiagraphy (ultrasound of heart), Radionuclide ventriculography, MRI, left ventriculogrophy and screening tests.

Question 5

What is the recommended first line screening type for heart failure?

Answer 5

BNP (Brain (B-type) natriuretic peptide): Amino acid peptide can be measured easily in blood. This will be elevated in heart failure hence a low BNP means it is not heart failure. Recommended first line test for patients with heart failure. Stable, easy to use test, can be measured at bed side.

Question 6

What is the cardiac abnormality that may cause heart failure?

Answer 6

• LV systolic dysnfunction
• Valvulare heart diseasse
• Pericardial constriction or effusion
• LV Diastolic dysnfuction/heart failure with preserved systolic function/heart failure with normal ejection fraction
• Cardiac arrhythmias: tach or brady
• Myocardial Infarction/ischaemia
• Restrictive cardiomyopathey

Question 7

LV systolic dysnfunction

Answer 7

Ischaemic heart disease (MI in coronary artery
Dilated cardiomyopathy: means LVSD not due to IHD or secondary to other lesion ie valves

Question 8

What is LV systolic dysnfunction caused by?

Answer 8

• Inherited
• Toxins
• Viral: acute myocarditis or chronic DCM
• Other infective: HIV, chaga’s disease, Lyme’s disease…….
• Systemic Diseases

Question 9

What is the diagnostic evaluation of patients with LVSD?

Answer 9

Take a detailed hsitory
Consider familial DCM
Exclude renal failure, aneamia
Possibly to autoantibodies/viral serology
Consider need to exclude