Heart Failure - Presentation and Investigation Flashcards
What is heart failure?
A clinical syndrome comprising of dyspnoea, fatigue or fluid retention due to cardiac dysfunction, either at rest or on exertion, with accompanying neurohormonal activation
What are the symptoms of heart failure?
Breathlessness
Fatigue
Oedema
Reduced exercise capacity
What are the signs of heart failure?
Oedema Tachycardia Raised JVP Chest crepitations or effusions 3rd heart sound Displaced or abnormal apex beat
How do you diagnose heart failure?
Symptoms or signs of heart failure at rest or on exercise
Objective evidence of cardiac dysfunction
Response to therapy
How do you get objective evidence of cardiac dysfunction?
Echocardiography
Radionuclide ventriculography
MRI
Left ventriculography
What are the potential screening tests for heart failure?
12 lead ECG
BNP
How does BNP work?
Amino acid peptide is elevated in heart failure so the BNP test measures its levels
Which is the more reliable screening test and prognosis test?
BNP
What has to be done when heart failure is diagnosed?
The underlying structural abnormality has to be diagnosed
What are the possible causes of heart failure?
LV systolic dysfunction Valvular heart disease Pericardial constriction or effusion LV diastolic dysfunction Cardiac arrhythmias: tacky or brady MI Restrictive cardiomyopathy RV failure
What does an Echo show?
LV systolic function Valvular dysfunction Pericardial effusion/tamponade Diastolic dysfunction LVH Atrial/ventricular shunt Complex congenital heart defects Pulmonary hypertension
What is the left ventricular ejection fraction?
A continuous biological variable and is the fraction of blood ejected from the LV with each heart beat
What affects LV ejection fraction and in what way?
Disease and physiological changes can both increase and decrease LVEF
What is the severity scaling for LV ejection fraction?
Normal - 50-80%
Mild - 40-50%
Moderate 30-40%
Severe - <30%
What is the best way to measure LV ejection fraction?
Multiple-gated acquisition scan (MUGA)
What is the grading of heart failure?
New York Association classification of heart failure (NYHA)
What does NYHA class 1 mean?
No limitation to exercise and no symptoms during usual activity
What does NYHA class 2 mean?
Mild limitations to exercise and is comfortable at rest and mild exertion
What does NYHA class 3 mean?
Moderate limitations to exercise and comfortable only at rest
What does NYHA class 4 mean?
Severe limitations to exercise and any physical activity brings on discomfort and symptoms occur at rest
What can heart failure cause?
Cardiac dysfunction Renal dysfunction Skeletal dysfunction Systemic inflammation Neurohormonal activation Systemic disorder
What is the treatment of heart failure due to LV systolic dysfunction?
Diuretics
ACE inhibitors
Aldosterone receptor blockers
ARBs
What are ACE inhibitors or ARBs replaced by in some patients?
Angiotensin receptor neprilysin inhibitor (ARNIs)
What are the causes of LV systolic dysfunction?
Ischaemic heart disease
Dilated cardiomyopathy
Severe aortic valve disease
Mitral regurgitation
