Week 4 - Chronic Heart Failure

Question 1

What are symptoms of heart failure?

Answer 1

dyspnoea, fatigue, oedema, reduced exercise ability, cough with white/pink frothy mucus

Question 2

What are 5 clinical signs of heart failure?

Answer 2

pulmonary oedema
raised JVP
tachycardia
3rd heart sound
crepitations/effusions

Question 3

Why is heart failure difficult to diagnose?

Answer 3

most symptoms are non-specific and a lot are also insensitive - not all heart failure patients have it.

Question 4

What is the 1yr survival rate of heart failure?

Answer 4

61% - worse than many cancers

Question 5

What are risk factors for heart failure?

Answer 5

MI, age, hypertension, diabetes, CHD, obesity

Question 6

What scans can be used to diagnose heart failure?

Answer 6

ECG
Xray - cardiomegaly, pleural effusion and oedema
Echocardiography
MUGA
MRI

Question 7

What could be used as screening tests for heart failure?

Answer 7

12 lead ECG.
BNP - brain natriuretic peptide. indicated abnormal ventricular distension. higher levels mean worse heart failure

Question 8

What is LVSD?

Answer 8

left ventricular systolic dysfunction

Question 9

What causes heart failure?

Answer 9

structural cardiac abnormality. any abnormality severe enough will cause heart failure

Question 10

What is a benefit of BNP test?

Answer 10

very useful and reliable screening test.
higher BNP level in HF means more advanced HF

Question 11

What info do you need to diagnose Heart Failure? (3)

Answer 11

• symptoms and signs of HF at rest or exercise,
• evidence of cardiac dysfunction.
• response to therapy

Question 12

How do you diagnose patients with LVSD?

Answer 12

history is most important.
CXR, ECG and echocardiogram

Question 13

What are benefits of echocardiography?

Answer 13

simple, non-invasive, bedside. checks abnormalities in heart structure and defects. can see many views

Question 14

What types of abnormalities can be detected by an echocardiogram?

Answer 14

valves, LVSD, ASD or VSD, diastolic dysfunction, hypertrophy

Question 15

What is LVEF?

Answer 15

left ventricular ejection fraction. shows how impaired LV is.

Question 16

How do you calculate LVEF?

Answer 16

biplane modified simpsoms rule. divide LV cavity into thin slices and calculate volume of each.

Question 17

How do we class LV function?

Answer 17

using LVEF.
normal - 55-70%
mild - 40-55%
moderate - 30-40%
severe - <30%

Question 18

What is a MUGA scan used for? whats positive and negative?

Answer 18

easier way and gets more accurate LVEF than biplane modified simpsons rule. but has ionising radiation

Question 19

What is a cardiac MRI used for and its positives and negatives?

Answer 19

benefit of echo and accuracy of MUGA together. image quality better, gives tissue characteristics like masses, hypertropy, LVEF.

not ideal for valve function
must hold breath, takes time, expensive, claustrophobia

Question 20

How is heart failure graded?

Answer 20

NYHA class - new york heart association class
mildest - no symptoms
mild limitation - comfortable with rest/ mild exertion
moderate limitation - comfortable only at rest
severe limitation - any physical activity brings discomfort and symptoms at rest

Question 21

What types of systemic conditions can cause heart failure?

Answer 21

• cardiac dysfunction,
• renal dysfunction,
• skeletal muscle dysfunction,
• systemic inflammation or
• neurohormonal activation

Question 22

How is neurohormonal activation involved in heart failure?

Answer 22

renin-angiotensin-aldosterone system when triggered controls vasoconstriction and blood volume - affects heart in many ways

Question 23

What are 4 main causes of chronic heart failure?

Answer 23

HAVI
hypertension, arrhythmias, valves, ischaemia