Heart Failure

Question 1

How do we define heart failure?

Answer 1

as a complex clinical syndromethat can occur from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with, or eject blood (Hunt, Baker et al. 2001).

Question 2

Is heart failure a disease or a syndrome?

Answer 2

it is a syndrome, not a pathological condition like myopathy - just because you have myopathy doesn’t mean you have heart failure

Question 3

Is all failure caused by failure of the heart to pump?

Answer 3

no - could have high output cardiac failure due to anaemia, thyrotoxicosis, and arterio-venous malformations

Question 4

What is systolic heart failure? what about diastolic heart failure?

Answer 4

systolic heart failure = trouble pumping blood

diastolic heart failure= trouble filling with blood

Question 5

can you have both diastolic and systolic dysfunction?

Answer 5

yes - systolic dysfunction is often accompanied by a failure to fill left ventricle - therefore systolic/diastolic go hand in hand

Question 6

is the depolarization or repolarization part of cardiac activity most disturbed in heart failure?

Answer 6

The passive part of muscle contraction is the depolarization, therefore the ’repolarization’ is the part that is generally disturbed in hart failure

Question 7

is diastolic or systolic left ventricular dysfunction more common?

Answer 7

systolic dysfunction is more common

Question 8

what is the muscle in the heart’s response to heart failure

Answer 8

muscle in the heart switches on the ‘fetal gene program ‘ so it goes from being nice muscle to floppy muscle

Question 9

What are the symptoms of heart failure?

Answer 9

Dyspnoea

chest pain

oedema

fatigue

early satiety

palpitations

syncopy

Question 10

what is the physiological response to heart failure?

Answer 10

• salt retention
• water retension
• circulatory shift
• initially these are helpful as increased circulating volume maintains adequate cardiac output = but it eventually becomes counter productive - leads to increased stretch on myocardium

Question 11

Where is angiotensin made? Where is it converted?

Answer 11

angiotensin made in liver

converted in the renal renin

then lung ACE convertes Angiotensin 1 to angiotensin 2

Question 12

what is the mortality of heart failure?

Answer 12

up to 50% mortality in 5 years - certain subgroups have worse prognosis than metastatic cancer!

Question 13

what are some of the most important causes of heart failure?

Answer 13

• coronary artery disease (most common cause in developed economies)
• hypertension (particularly important cause of diastolic heart failure)
• cardiomyopathy
• toxic - alcoholic myocardopathy, cocaine, or chemotherapy drugs
• valvular heart disease
• arrhythmias

Question 14

what is the term ‘remodelling’ as it relates to heart failure?

Answer 14

important to understand progression of left ventricular dysfunction

initial compensatory hypertrophy of the muscle follows with fibrosis, dilation and progressive dysfunction

Question 15

as a rule, volume overload causes what in the heart?

Answer 15

causes chamber dilatation (i.e. aortic incompetence, mitral regurgitation)

Question 16

what are the different types of cardiomyopathy?

Answer 16

dilated

hypertrophic (thickend heart)

arrhythmogenic right ventricular cardiomyopathy

restrictive cardiomyopathy

*often these are genetic/famiial

Question 17

what are the major classes of cardiomyopathy?

Answer 17

ischaemic vs. non-ischaemic

systolic vs . diastolic

Question 18

what are the symptoms of heart failure?

Answer 18

dyspnoea on exertion

paroxysmal noctural nyspnea

tachycardia

cough

haemoptysis

abdominal pain

anorexia

nausea

bloating

swelling

*all of these are the same wehther diastolic/systolic heart failure*

Question 19

how do we determine diastolic vs. systolic heart failure?

Answer 19

depends on their ejection fraction

if greater than 40% = diastolic heart failure

if less than 40% = systolic heart failure

but remember that almost all systolic heart failure has a component of diastolic failure.

Question 20

What are the different classes of heart failure according to the new york heart association?

Answer 20

Class I: No symptoms with ordinary activity

Class II: Slight limitation of physical activity. Comfortable at rest,
but ordinary physical activity results in fatigue,
palpitation, dyspnea, or angina

Class III: Marked limitation of physical activity. Comfortable at
rest, but less than ordinary physical activity results in
fatigue, palpitation, dyspnea, or anginal pain

Class IV: Unable to carry out any physical activity without
discomfort. Symptoms of cardiac insufficiency may be
present even at rest

Question 21

what are the ‘signs’ of heart failure?

Answer 21

basilar rales

pulmonary/peripheral oedema

S3 Gallop?

pleural effusion

cheyne stokes respiration

jugular venous distention

abdominal-jugular reflux

hepatomegaly