Heart Failure - Presentation and Investigation

Question 1

What is 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?

Answer 2

Breathlessness
Fatigue
Oedema
Reduced exercise capacity

Question 3

What are the signs of heart failure?

Answer 3

Oedema 
Tachycardia 
Raised JVP 
Chest crepitations or effusions 
3rd heart sound
Displaced or abnormal apex beat

Question 4

How do you diagnose heart failure?

Answer 4

Symptoms or signs of heart failure at rest or on exercise
Objective evidence of cardiac dysfunction
Response to therapy

Question 5

How do you get objective evidence of cardiac dysfunction?

Answer 5

Echocardiography
Radionuclide ventriculography
MRI
Left ventriculography

Question 6

What are the potential screening tests for heart failure?

Answer 6

12 lead ECG

BNP

Question 7

How does BNP work?

Answer 7

Amino acid peptide is elevated in heart failure so the BNP test measures its levels

Question 8

Which is the more reliable screening test and prognosis test?

Answer 8

BNP

Question 9

What has to be done when heart failure is diagnosed?

Answer 9

The underlying structural abnormality has to be diagnosed

Question 10

What are the possible causes of heart failure?

Answer 10

LV systolic dysfunction 
Valvular heart disease 
Pericardial constriction or effusion 
LV diastolic dysfunction 
Cardiac arrhythmias: tacky or brady 
MI 
Restrictive cardiomyopathy 
RV failure

Question 11

What does an Echo show?

Answer 11

LV systolic function 
Valvular dysfunction 
Pericardial effusion/tamponade 
Diastolic dysfunction 
LVH 
Atrial/ventricular shunt 
Complex congenital heart defects 
Pulmonary hypertension

Question 12

What is the left ventricular ejection fraction?

Answer 12

A continuous biological variable and is the fraction of blood ejected from the LV with each heart beat

Question 13

What affects LV ejection fraction and in what way?

Answer 13

Disease and physiological changes can both increase and decrease LVEF

Question 14

What is the severity scaling for LV ejection fraction?

Answer 14

Normal - 50-80%
Mild - 40-50%
Moderate 30-40%
Severe - <30%

Question 15

What is the best way to measure LV ejection fraction?

Answer 15

Multiple-gated acquisition scan (MUGA)

Question 16

What is the grading of heart failure?

Answer 16

New York Association classification of heart failure (NYHA)

Question 17

What does NYHA class 1 mean?

Answer 17

No limitation to exercise and no symptoms during usual activity

Question 18

What does NYHA class 2 mean?

Answer 18

Mild limitations to exercise and is comfortable at rest and mild exertion

Question 19

What does NYHA class 3 mean?

Answer 19

Moderate limitations to exercise and comfortable only at rest

Question 20

What does NYHA class 4 mean?

Answer 20

Severe limitations to exercise and any physical activity brings on discomfort and symptoms occur at rest

Question 21

What can heart failure cause?

Answer 21

Cardiac dysfunction 
Renal dysfunction 
Skeletal dysfunction 
Systemic inflammation 
Neurohormonal activation 
Systemic disorder

Question 22

What is the treatment of heart failure due to LV systolic dysfunction?

Answer 22

Diuretics
ACE inhibitors
Aldosterone receptor blockers
ARBs

Question 23

What are ACE inhibitors or ARBs replaced by in some patients?

Answer 23

Angiotensin receptor neprilysin inhibitor (ARNIs)

Question 24

What are the causes of LV systolic dysfunction?

Answer 24

Ischaemic heart disease
Dilated cardiomyopathy
Severe aortic valve disease
Mitral regurgitation