Chronic Heart Failure: epidemiology, investigation and diagnosis

Question 1

What is the definition of heart failure

Answer 1

A clinical syndrome comprising of dyspnoea, fatigue or fluid retention due to cardiac dysfunction, either at rest or on exertion, with accompanying neurohormonal activation

Question 2

Why is heart failure not the ending diagnosis

Answer 2

As need to investigate underlying cause

Question 3

Aetiology of heart failure

Answer 3

Valve heart disease
aortic stenosis - excessive afterload
Mitral/aortic regurgitation - excessive preload
Arial/ventrical septal defect/ tricuspid incompetence - excessive preload

Hypertension

Coronary heart disease

Stuctural abnormailites

Myocardial ischaemia

dilated cardiomyopathy

Question 4

What is the symptoms of heart failure

Answer 4

breathlessness
Fatigue
Reduced exercise capacity

Question 5

What is the signs of heart failure

Answer 5

Odema
Tachycardia
raised JVP
chest crepitations or effusions
3rd heart sound
Displaced or abnormal apex beat

Question 6

Why is making a diagnosis of heart failure difficult

Answer 6

Majority of the symptoms and sings are non specific therefore evidence of cardiac dysfunction is mandatory

Question 7

What are the non specific signs and symptoms of heart failure

Answer 7

Chest crepitations, oedema,
tachycardia
dyspnoea
fatigue

Question 8

What is the specific signs and symptoms of heart failure

Answer 8

Increased JVP
Third systolic heart sound S3
Displaced apex

Question 9

What is the three steps in the diagnosis of heart failure

Answer 9

1 symptoms or signs of HF (rest or exercise)
and

2 objective evidence of cardiac dysfunction

3 response to therapy

Question 10

What therapy is used to test the response in doubtful cases of heart failure

Answer 10

Diuretics

Question 11

What will provide objective evidence of cardiac dysfunction in the diagnosis of heart failure than

Answer 11

abnormal ECHO
-cardiomegaly
Cardiac murmurs -S3
raised natriuretic peptide concentration

Question 12

What is LVSD defined as on an ECHO

Answer 12

LV ejection fraction

Question 13

What is the benefits of ECHO investigation

Answer 13

Easy to perform
non invasive
Looks at valve function
detects atrial fibrillation

Question 14

What are the two screening tests for heart failure

Answer 14

12 lead ECG

BNP

Question 15

If ECG appears normal in heart failure, what aetiology becomes unlikely

Answer 15

Left ventricular systolic disfunction

Question 16

How does BNP working in detecting heart failure

Answer 16

BNP is an amino acide peptide that becomes elevated in heart failure (if low not HF)

Question 17

An elevated BNP requires what further action

Answer 17

ECHO/cardiac assessment

Question 18

When would heart failure be classed as diastolic

Answer 18

Has normal systolic function:

Normal ejection fraction and no obvious increased myocardial demand

Question 19

What does an ECHO enable the assessment of

Answer 19

Over all LV systolic function - LV ejection fraction

pericardial effusion

Diastolic function

LV wall thickness - cardiomegaly

Valvular disease

Estimation of pulmonary artery systolic pressure

Question 20

What are further imaging investigations for heart failure LVSD

Answer 20

MRI
CXR
MUGA
ECG

Question 21

What is a normal LV ejection fraction and a severe

Answer 21

Normal 50-80%

severe - <30%

Question 22

Why is it difficult to quantify LV ejection fraction on an ECHO sometimes

Answer 22

Quality of the images 
experience of the operators 
the calculation method 
use of contrasting agents
Time consuming to perform accurately

Question 23

How does simpsons biplane work in calculating the volume of the ejection fraction

Answer 23

divide LV cavity into multiple slices of known thickness and diameter, then work out the volume by timing the area by the thickness

(thinner slices more accurate volume)

Question 24

What is the imaging technique MUGA composed of

Answer 24

radionuclide angiogram

evaluates the pumping function of the ventricles as the radioactive tracer is injected into the vein

Question 25

Why is MUGA better than ECHO

Answer 25

Much easier to obtain the acurate figure for LVEF Greater reproducibility No additional structural information

Question 26

What is the causes of LV systolic dysfunction

Answer 26

dilated cardiopathy coronary heart disease Valve heart disease

Question 27

How does aortic stenosis cause heart failure

Answer 27

cause left ventricular hypertrophy (LVH) due to chronic excessive afterload.

Question 28

What is the exercise tolerance and symptoms in class 1 -4 of graded heart failure

Answer 28

CLASS 1 Exercise tolerance - no limitations Symptoms - none during usually activity CLASS 2 Exercise tolerance - mild limitations Symptoms - comfortable with rest of mild exertion CLASS 3 Exercise tolerance - moderate limitations Symptoms - comfortable only at rest CLASS 4 Exercise tolerance - severe limitations Symptoms - any physical activity brings on discomfort and symptoms occur at rest

Question 29

Why is heart failure not always to do with cardiac output

Answer 29

As the greater the size of the heart, it has the same cardiac output, but has a greater end diastolic volume, therefore smaller LV ejection fraction

Question 30

What is the pharmacological therapy for heart failure

Answer 30

– Diuretics –ACE inhibitors – Betablockers –Aldosterone receptor blockers –In some pateints ACE I or ARDB now replaced by angiotensin receptor neprilysin inhibitor

Question 31

How is heart failure a systemic disorder

Answer 31

as envolves neurohormonal activation

Question 32

What can causes neurohormonal activation w

Answer 32

Vasoconstriction Endothelial dysfunction Renal sodium retention

Question 33

What is the possible outcomes of neurohormonal activation

Answer 33

Left ventricular injury Left ventricular dysfunction heart failure