Heart Failure (with preserved systolic function)

Question 1

Non-modifiable risk factors

Answer 1

-Age
-Gender (F>M)

Question 2

Modifiable risk factors

Answer 2

-Hypertension/ Type 2 diabetes
-Obesity
-Coronary artery disease

Question 3

Other conditions related to heart failure with preserved ejection fraction

Answer 3

-Hypertrophic/ infiltrative heart disease (cardiac amyloidosis/ haemochromatosis)
-Radiation therapy

Question 4

Pathophysiology of heart failure with preserved EF

Answer 4

-Stiff pump
=Impaired ventricular filling

=Increased ventricular wall mass (non-compliant)
=Reduced volume in ventricle

=Unable to meet metabolic demands of body

Question 5

Symptoms of HFpEF

Answer 5

-Fatigue/ reduced effort tolerance
-Breathlessness (back pressure in left atrium, pressure in pulmonary vein, pulmonary oedema)
-Orthopnoea/ Paroxysmal nocturnal dyspnoea
-Swollen ankles

Question 6

Clinical signs of HF-PEF

Answer 6

-Crackles in lungs
-Raised JVP
-Central congestion (hepatomegaly, ascites)
-Peripheral congestion (bilateral lower limb pitting oedema)
-Rare: extra HS (S3 gallop in HFrEF, S4 in HFpEF)

Question 7

Investigations of HF-PEF

Answer 7

-ECG (no specific changes but will likely be abnormal like LVH or BBB)
-CXR (cardiomegaly and pulmonary congestion)
-NTproBNP/ N-terminal pro B-type natriuretic peptide (elevated, released when increased intraventricular pressures)

1. Echo= diastolic dysfunction (HR-REF systolic)

Question 8

Treatment of acute decompression of HF-PEF

Answer 8

Loop diuretic therapy

Question 9

Treatment of chronic phase HF-PEF

Answer 9

-RAAS inhibition
=ACEi, ARBs and mineralocorticoid antagonists
-Sympathetic inhibition
=Beta-blockers
-Loop diuretic therapy