HF

Question 1

Define HF

Answer 1

A syndrome where the heart is unable to maintain an adequate circulation for the metabolic requirements of the body

Question 2

Describe the epidemiology of HF?

Answer 2

Prevalence & incidence increases with age (10% prevalence in over 60s)

Poor prognosis - 5-year mortality rate of 50% mortality

Question 3

Name the types of heart failure?

Answer 3

Chronic
o preserved ejection fraction (HFpEF) “diastolic HF”
oreduced ejection fraction (HFrEF) “systolic HF”

Acute
o De novo
o Acute decompensation

Question 4

Describe the causes of heart failure?

Answer 4

• IHD
Most important risk factor
35-60% of cause
Reduced blood supply –> myocardial damage

• Hypertension
4-78% of cause of chronic
Increased afterload –> increased LV workload

• Valvular heart disease
7-31% of cause of chronic
Stenosis & regurgitation –> increased cardiac workload

• Hormonal
Neurohormonal - changes in the ANS
Renal - changes in the RAAS

Question 5

What symptoms and signs are associated with HF?

Answer 5

Symptoms
• Breathlessness
• Tachycardia
• Oedema

Signs
• 3rd Heart Sound: low-pitched sound during early diastole due to rapid deceleration of blood flow from atria to ventricles
• Raised JVP: indicative of increased volume & prognostic indicator of poor outcome

Question 6

List investigations of HF?

Answer 6

BNP
NT-pro-BNP
Echocardiography
ECG
CXR

Question 7

Describe pharmacological treatment of HF?

Answer 7

Renin-Angiotensin system:

1. ACE inhibitors - reduce mortality in HF patients
2. Angiotensin receptor blockers - equivalent benefit to ACEi

Sympathetic nervous system
1. Beta-blockers (e.g. carvedilol) have proven efficacy and reduce mortality. Not all beta-blockers effective.

Renal system
1. Aldosterone antagonists (e.g. Spironolactone)
Effective in combination with ACEi
2. Loop diuretics (e.g. Furosemide) recommended if volume overload is present. Treatments only really effective for treatment of HFrEF (i.e. systolic HF).

Question 8

Describe surgical treatment of HF?

Answer 8

1. Heart transplant
   Most effective treatment for end-stage heart failure
2. Resynchronisation therapy
   3-lead pacemaker effective in patients with dilated LV
   Additional cardiac defibrillator is beneficial in some patients

Question 9

In a CXR used to investigate HF, what would you expect to find?

Answer 9

1. Cardiomegaly: enlarged heart. Cardiothoracic ratio >50%
2. Plural effusions: excess fluid is lung pleura
3. Upper lobe diversion: increased size of upper lobe vessels

Question 10

In an ECG used to investigate HF, what would you expect to find?

Answer 10

No specific characteristics for heart failure

Pathological Q waves - previous MI

Question 11

In a blood test used to investigate HF, what would you expect to find?

Answer 11

Biomarkers:
B-type Natriuretic peptide (BNP)
Released from the ventricles following stretch
NT-pro-BNP (N-terminal-pro-brain natriuretic peptide)

Question 12

In an echocardiogram used to investigate HF, what could you find?

Answer 12

Ultrasound image showing structure of the heart:
Valvular structure
Wall motion abnormalities (CAD)