Lecture 10.1: Heart Failure

Question 1

What percentage of acute hospital admissions are Heart Failure?

Answer 1

5%

Question 2

What are the Most Common Causes of Heart Failure? (6)

Answer 2

• Myocardial Infarction
• Hypertension
• Ischaemia
• Faulty Heart Valves
• Atrial/Ventricular Fibrillation
• Coronary Artery Disease

Question 3

What is Heart Failure?

Answer 3

“ Heart failure can be defined as an abnormality
of cardiac structure or function leading to failure
of the heart to deliver oxygen at a rate
commensurate with the requirements of
the metabolising tissues, despite normal filling
pressures (or only at the expense of increased
filling pressures) ”

Question 4

What Neurohormones are elevated in HF? (5)

Answer 4

• SNS Activity
• Renin-Angiotensin System (RAS)
• Endothelin
• ANP/BNP (Atrial and Brain Natriuretic
  Peptides)
• Cytokines

Question 5

Investigations for Heart Failure

Answer 5

• ECG
• Echocardiogram
• Lab Tests (blood, urine…etc)
• Chest X-Ray

Question 6

Symptoms of Heart Failure (6)

Answer 6

• Difficulty breathing when lying down
• Oedema in feet/ankles
• Breathlessness
• Fatigue
• Weakness
• Heart Palpitations

Question 7

Adjunct Tests to help Diagnosis of Heart Failure (7)

Answer 7

• Dobutamine Stress Echocardiogram (DSE)
• Exercise Electrocardiogram (ETT)
• Angiography
• RHC / myocardial biopsy
• Cardiovascular Magnetic Resonance (CMR)
• Genetic Testing
• Ambulatory ECG

Question 8

Mineralocorticoid Receptor Antagonists in HFrEF: Examples and MoA

Answer 8

• Spironolactone
• Eplerenone
• Decrease the aldosterone effect by binding to
  the mineralocorticoid receptor inhibiting
  aldosterone
• This leads to higher levels of potassium in
  serum and increased sodium excretion
• Resulting in decreased body fluid and lower
  blood pressure

Question 9

I(f) Channel Blocker in HFrEF: Examples and MoA

Answer 9

• Ivabradine
• Acts by selectively and specifically inhibiting the
  cardiac pacemaker current
• Slows SA nodal conduction (slows HR)

Question 10

What is HFrEF?

Answer 10

Heart Failure with Reduced Ejection Fraction

Question 11

What is HFpEF?

Answer 11

Heart Failure with Preserved Ejection Fraction

Question 12

Treatments for HFpEF

Answer 12

• HFrEF medicines do not work.
• Small (<30 patients) studies have shown rate
  limiting calcium channel blockers may
  improve symptoms

Question 13

Rate-Limiting Calcium Channel Blockers (CCBs): Examples & MoA

Answer 13

• Diltiazem
• Verapamil
• CCBs promote vasodilator activity (and reduce
  blood pressure)
• By reducing calcium influx into vascular smooth
  muscle cells by interfering with voltage-operated
  calcium channels (and to a lesser extent
  receptor-operated channels) in the cell
  membrane

Question 14

What is the use of Diuretics in Systolic and
Diastolic HF?

Answer 14

• Not proven to improve life expectancy
• Do relieve symptoms of dyspnoea and oedema
• Aim for euvolaemia
• May need to adjust to prevent dehydration,
  hypotension and worsening HF

Question 15

Non-Pharmacological Treatment for HFrEF: ICDs

Answer 15

• Implantable Cardioverter Defibrillators (ICDs)
• Reduce mortality for survivors of cardiac
  arrest and patients with documented ventricular
  arrhythmias

Question 16

Non-Pharmacological Treatment for HFrEF: CRT

Answer 16

• Cardiac Resynchronisation Therapy (CRT)
• It is a treatment to help your heart beat with the
  right rhythm
• It uses a pacemaker to restore the normal timing
  pattern of the heartbeat

Question 17

Therapeutic Interventions in HF

Answer 17

Exercise Training

Question 18

Benefits of Exercise Training in HF (9)

Answer 18

• Central adaptations (improved systolic and
  diastolic function)
• Improved O2 handling and efficiency
• Increased muscle strength
• Increased endurance
• Improved vascular function
• Reduced Inflammation
• Improved Insulin Modulation
• Psychology/Mental Health Benefits
• Improved Prognosis

Question 19

Name 5 Commonly Co-Morbidities associated with HF (15)

Answer 19

• Hypertension
• IHD (Ischaemic Heart Disease)
• Diabetes Mellitus
• Renal Failure (Cardio-Renal Syndrome)
• COPD
• Anaemia
• Erectile Dysfunction
• Testosterone Deficiency
• Cachexia
• Depression
• Gout
• Cancer
• Hyperlipidaemia
• Obesity
• OSAH (Obstructive Sleep Apnea Hypopnea)

Question 20

Surgical Interventions for HF (2)

Answer 20

• LVAD (Left Ventricular Assist Device)
• BiVAD (Biventricular Assist Device)

Question 21

Heart Transplantation: When is it done? Who is it available to?

Answer 21

• Final option for end-stage HF
• Only available in carefully selected patients