L18 - Investigations And Management Of Heart Failure

Question 1

Briefly describe the classes of heart failure

Answer 1

Class I - no symptomatic limitation of physical activity
Class II - slight limitation of physical activity
Class III - marked limitation of physical activity
Class IV - inability to carry out any physical activity without symptoms

Question 2

In heart failure there are symptomatic (supportive) and prognostic (specific) treatments. Give an example of the symptomatic treatment and the prognostic treatment for LVSD HF (left HFrEF)

Answer 2

Symptomatic - furosemide (loop diuretic)
Prognostic - ACEI/ARB
Beta blocker
Spironolactone
Sacubitril valsartan (partly acts by working as an ARB)
Biventricular pacemaker
Ivabradine/hydralazine

Question 3

In a patient who is extremely breathlessness, with severe tachycardia and bilateral crepitations, how would you treat?

Answer 3

This is an emergency 
ABCDE 
Furosemide
Oxygen 
Respiratory support
Nitrates and morphine

Question 4

What are the key investigations needed in someone with HF? What are you looking for in each?

Answer 4

Most importantly NTpro-BNP - hormone released due to chamber stretch from fluid overload
CXR - cardiomegaly, pleural effusions, fluid
Transthoracic echocardiogram - hypertrophy/ mitral regurgitation/ aortic stenosis
Coronary angiogram
ECG - AF or other arrythmias/ left bundle branch block
FBC - patients often anaemic
U’s and E’s - renal function often poor
LFT’s - hepatic congestion I’m right failure
Thyroid function - thyrotoxicosis is an alternative to cause of heart failure due to causing high peripheral demand
CRP - look for inflammation/infection

You would do different ones of these depending on symptoms

Question 5

What are the early compensatory mechanisms to improve CO output in normal people and Hf patients?

Answer 5

Increased cardiac contractility, arterial and venous vasoconstriction, tachycardia (SNS activation)

Upregulation of the RAAS and the effects that come with that - what are these look at paper

Question 6

Why do we need to titrate B blockers slowly in HF patients?

Answer 6

Because the failing myocardium may be dependent on HR, if this is the cause of the problem

Question 7

Explain two of the four favourable effects that beta blockers have in heart failure patients

Answer 7

Reduce myocardial oxygen demand by reducing HR and BP (CO)/reduce mobilisation of glycogen/ negate unwanted effects of catecholamines