Heart Failure ☺️

Question 1

Describe hypertrophic cardiomyopathy

• epidemiology
• pathophysiology
• signs, symptoms

Answer 1

Genetic (AD) => main cause of sudden cardiac death in young due to ventricular arrythmias
Can be due to HTN

Diastolic dysfunction or increased afterload => LV hypertrophy and radius decreases

Signs and symptoms

• asymptomatic
• syncope, ventricular arrythmias,

Question 2

Describe dilated cardiomyopathy

• epidemiology
• pathophysiology
• signs, symptoms

Answer 2

Most common due to CHD, HTN

Systolic dysfunction or systolic valve problems => LV radius and wall thickness increases

Signs and symptoms

• systolic murmur
• HF signs, S3

Question 3

What is acute heart failure

• pathophysiology
• etiology

Answer 3

Sudden onset/worsening of HF
-low CO from functional/structural abnormality => reduced CO, perfusion => pulmonary edema

• ISCHEMIA (most common)
• ACS
• HTN crisis
• acute arrythmias
• valvular disease
• infectious myopathy

Question 4

Presentation of AHF

Answer 4

SOB, fatigue, reduced exercise tolerance

Cyanosis
High HR
High JVP
Displaced apex beat
Bibasal crackles, peripheral edema
S3

Question 5

Investigations for AHF

Answer 5

Bloods

• FBC - rule out anemia, infective causes
• U&E - electrolyte imbalances
• BNP - 100+ indicates myocardial damage

Scans 
-CXR 
Alveolar edema
B lines - interstitial edema
Cardiomegaly
Diversion of vessels => upper zones
Effusion
-Echocardiogram - any cardiac tamponade?

Question 6

Management of AHF

• management of regular HF meds
• treatment for all
• if resp failure
• if hypotensive/cardiogenic shock

Answer 6

Continue regular meds for HF (Bb, ACEi)
-stop Bb if bradycardic/heart block

IV loop - furosemide or bumetanide

O2 - aim for 94-98%
VD - GTN if HTN/aortic regurg/mitral valve disease
-CI/SE - hypotension

If in resp failure - CPAP

If hypotensive/cardiogenic shock

• inotropes - dobutamine
• vasopressors - NA
• mechanical circulatory assistance

Question 7

What is chronic heart failure

-pathophysiology

Answer 7

Neurohormonal - short term protection but long term damage

Vicious cycle of

• poor contractility => inadequate CO
• poor renal perfusion => activates RAAS, SNS
• increased fluid retention, VC => HTN
• increased stress on heart => cardiac remodelling but cannot be adequately be perfused => scar formation

Question 8

Presentation of chronic heart failure

Answer 8

SOB, orthopnea, paroxysmal noctural dyspnoea
Cough with pink, frothy sputum
Cachexia - but can be hidden by edema weight

Bibasal crackles
RHF, high JVP, ankle edema, hepatomegaly

Question 9

Investigations for chronic heart failure

• definitive
• bloods
• scans

Answer 9

Definitive - BNP
-if 400+ - LV strain

-FBC => anemia due to chronic poor renal perfusion

ECG, CXR, Echo => electrical, effusions, physical abnormalities

Question 10

Management of CHF

Answer 10

1st line
-ACEi and Bb
2nd line
-Aldosterone antagonist => monitor K 
3rd line
-Ivabradine/sacubitril-valsartan/digoxin

Annual influenza vaccine
One off pneumococcal vaccine