Chronic Heart Failure

Question 1

What is heart failure

Answer 1

Heart failure is the inability of the heart muscles to pump blood around the body.

Question 2

What are the causes of heart failure? Name 4

Answer 2

-IHD: myocardial ischaemia causes cell death and then inability of the heart muscle to pump blood
-HTN: heart muscle has to pump harder against resistance so it puts strain on your ventricles
-Valvular disease e.g. Aortic stenosis, the heart muscle has to work harder against the valves and so this weakens your heart muscle
-Arrhythmias e.g. AF (big risk factor) can cause heart failure if your heart is pumping too fast and too often so this can weaken your heart muscle

Question 3

Symptoms of heart failure

Answer 3

Breathlessness - worse in exertion
Fatigue
Orthopnoea - SOB lying flat, relieved by lying upright
Paroxysmal noctural dyspnoea - SOB that suddenly wakes you up at night. Hence you ask how many pillows do you sleep with.
Pink frothy sputum

Question 4

Signs of heart failure

Answer 4

Peripheral oedema - swollen legs and ankles
Pulmonary oedema -> SOB and pink-frothy sputum
Increased JVP
Bi-basal crackles on auscultation
Displaced apex beat

Question 5

Investigations for heart failure. Name 4.

Answer 5

1. Brain Natriuretic Peptide (BNP) blood test - measures the amount of BNP in your blood. When your heart has to work harder, it releases the hormone BNP.
2. Echocardiography - looks for underlying abnormalities such as stenosis, regurgitation etc. Also measures EF.
3. CXR - look for ABCDE
4. ECG - signs of heart failure

Question 6

What BNP blood level is considered elevated and when would you refer for an echo?

Answer 6

-Greater than >400 should not be ignored
->2000 requires urgent echo referral
-<2000 requires routine echo referral

Question 7

What are the CXR signs for heart failure?

Answer 7

Alveolar oedema
B Kerley B lines
Cardiomegaly
Dilated upper lobe vessels
Effusion (Pleural)

Question 8

Treatment of heart failure

Answer 8

1st line: ACE-I + BB (bisoprolol, carvedilol, nebivolol)
2nd line: + mineralocorticoid receptor antagonist/aldosterone antagonist e.g. Spironolactone or Eplerenone
3rd line: Initiated by specialist e.g. ivabridine, digoxin, hydralazine,