Chapter 2: Heart Failure

Question 1

What is heart failure?

Answer 1

• Progressive clinical syndrome, caused by structural or functional abnormalites of the heart.
• results in reduced cardiac output

Question 2

What are the symptoms and signs of HF?

Answer 2

• SOB
• persistent coughing or wheezing
• ankle swelling
• reduced exercise tolerance
• fatigue

Question 3

What group of perplexing are t a greater risk of developing HF?

Answer 3

• Men
• smokers
• diabetic patients
• increasing age

Question 4

What is the most common cause of HF?

Answer 4

Coronary heart disease.

Afro-Caribbean patients are more likely to develop HF secondary to HTN

HF is often together with other co-morbidities such as:

• CKD
• AF
• HTN
• dyslipidaemia
• obesity
• diabetes mellitus
• chronic obstructive pulmonary disease

Question 5

What are the complications of HF?

Answer 5

CKD 
AF
Depression
Cachexia (weakness and wasting of the body)
Sexual dysfunction 
Sudden cardiac death

Question 6

What is HF with reduced ejection fraction?

Answer 6

Left ventricle loses it ability to contract normally and therefore presents with an ejection fraction of <40%.

Question 7

What is HF with preserved ejection fraction?

Answer 7

The left ventricle loses it ability to relax normally therefore the ejection fraction is NORMAL or SLIGHTLY REDUCED

Question 8

What tool is used to classify and determine the progression of CHF?

Answer 8

The New York heart association functional classification tool (NYHA)

According to the severity of symptoms and limitations of physical activity

Question 9

What are the non-drug treatment advice for HF?

Answer 9

• smoking cessation - reduce alcohol intake
• increase physical activity - more fruit and eg intake
• reduced salt intake (<6g daily)
• contraception and pregnancy advice to women.

Weigh themselves daily and report any weight gain of more than 1.5-2kg in 2 days to their GP.

Question 10

What drugs should be avoided in HF?

Answer 10

• Verapamil and diltiazem, nifedipine or nicardipine.
• can reduce the cardiac contractility.

Amlodipine is fine in patients with HF and angina

Question 11

Are diuretics recommended in HF? Explain the options

Answer 11

Yes, to relieve breathlessness and oedema in patient with fluid retention.

• loop diuretics are preferred (furosemide, bumetanide, torasemide)
• thiazides may be fine in patients with MILD fluid retention and have a eGFR>30ml/min

Question 12

What drugs are licensed and 1st line for HF?

Answer 12

ACEi/ARB + Beta blockers (bisoprolol, carvedilol or nebivolol)

• to reduce mortality and morbidity.
• if patient is already on a beta blocker for another condition (e.g. HTN or angina) SWITCH patient to a beta blocker licensed for HF.

Question 13

What drugs can be added to the 1st line treatment of HF if patient is still symptomatic or worsens?

Answer 13

+ spironolactone or eplerenone (aldosterone antagonists) unless CI (hypokalaemia or renal impairment).

Question 14

What drugs can be given for HF that can not tolerate ACEi/ARBS

Answer 14

-Hydralazine + nitrate

Especially for those of African or Caribbean backgrounds with moderate to severe HF.