Heart Failure - Presentation and Investigation

Question 1

What is the definition of heart failure?

Answer 1

A clinical syndrome comprising of dyspnoea, fatigue or fluid retention due to cardiac dysfunction either at rest or on exertion with accompanying neurohormonal activation

Question 2

What are the symptoms of heart failure?

Hint: They’re the same as every other fucking disease in this topic

Answer 2

Breathlessness, fatigue, oedema and reduced exercise capacity

Question 3

What are the signs of heart failure?

Answer 3

Oedema, tachycardia, raised JVP, chest crepitations or effusions, third heart sound, displaced or abnormal apex beat

Question 4

What percentage of heart failure cases are misdiagnosed?

Answer 4

40-50%

Question 5

What are the three criteria for diagnosis of heart failure according to the European Society of Clinical Cardiology?

Answer 5

1. Symptoms or signs of heart failure at rest or on exertion
2. Objective evidence of cardiac dysfunction
3. Response to therapy (diuretics for example)

Question 6

What useful investigations may be conducted to give objective evidence of cardiac dysfunction?

Answer 6

Echocardiography, Radionuclide ventriculography, ECG

Question 7

What tests may be used to screen for heart failure/

Answer 7

12 lead ECG and Brain Natriuretic Peptide (BNP)

Question 8

What is BNP a good indication for in terms of heart failure?

Answer 8

Predicts mortality and morbidity

Question 9

What is the parasternal long axis?

Answer 9

Cut heart in half along transverse plane (in vivo view)

Question 10

What is the parasternal short axis?

Answer 10

Cuts heart as it were stood perfectly upright from base to apex (unlike it is in vivo)

Question 11

What is the left ventricular ejection fraction?

Answer 11

A continuous biological variable looking at the fraction of blood ejected from the LV as a proportion of its total volume

Question 12

What mathematical principle is used to measure the ejection fraction?

Answer 12

Simpsons rule of numerical integration

Question 13

What scan can be used to accurately measure LVEF?

Answer 13

LVEF-MUGA (multigated radionuclide angiography)

Question 14

What neurohormonal systems play into heart failure?

Answer 14

RAAS and Sympathetic nervous system

Question 15

What are the four stages of heart failure according to the New York Heart Association?

Answer 15

Stage I - no limitation and asymptomatic

Stage II - Mild limitation and comfortable at rest and mild exercise

Stage III - Moderate limitation and only comfortable at rest

Stage IV: Severe limitation and symptomatic at rest