diagnosing and managing AHF/CHF in 2025

Question 1

7 things to check when diagnosing heart failure

Answer 1

1. underlying abnormlaity
2. severity
3. aetiology
4. precipitating
5. exacerbating
6. concomitant disease relative to the management
7. estimate prognosis

Question 2

common symptons of heart failure - 4

Answer 2

• shortness of breath
• oedema
• fatigue
• palpitations

Question 2

shortness of breath can present in which two ways

Answer 2

• dyspnea
• orthopnoea = when laying down

Question 2

familiarise yourself with the 11 other ways that a person can present with symptoms similar to those of HF

Question 2

orthopnoea and added heart sounds

Answer 2

high specificity - low sens

Question 2

5 clinical features of HF (vitals and general exam)

Answer 2

37.2°C → Normal temperature

Tachypnoeic (28/min) → Fast breathing = dyspnea (very common in HF)

Low volume pulse + cool peripheries → Poor perfusion → matches “cold” in “cold and wet”

BP 116/86 → Normal or slightly low (in context of HF, this may be low)

JVP raised 6 cm → Sign of fluid overload = congestion → matches “wet”

Question 2

categories of acute heart failure - 2

Answer 2

1. decompensated chronic heart failure - patient with knwon heart failure gets worse wslowly over days/ weeks
2. hypertensive HF - high blood pressure with severe SOB (rapidly progressive)

Question 2

dyspnea

Answer 2

high sensitivity - THE HIGHEST

Question 2

normal CXR

Answer 2

• CANNOT rule out the diagnosis
• but can be useful to rule out other pathology that may be responsible for symptoms such a breathlessness

Question 2

4 clinical features of HF (cardiac exam)

Answer 2

Apex in 6th ICS, 3 cm lateral to MCL → Displaced laterally and downward → LV enlargement

Parasternal lift (heave) → Suggests RV hypertrophy

3/6 PSM (pansystolic murmur) → Likely mitral regurgitation

S3 gallop → Classic in volume overload, strongly suggests HF

Question 2

natriuretic peptides diagnostic testing

Answer 2

high sensitivity

Question 2

abnormalities in ECG

Answer 2

diagnosis of conditions other than HF

Question 2

what features of HF does a chest x-ray show

Answer 2

• incr cardiothoracic ratio
• lung interstitial oedema
• bilateral pleural effusions

Question 2

normal ECG

Answer 2

high sensitivty

• HF is quiet unikely in the presence of a normal ECG

Question 2

CXR diagnostic testing

Answer 2

very high specificity

Question 2

function of these peptides

Answer 2

released by ventricles of the heart in response to volume and pressure overload (stretch)

Question 2

how is NP stored

Answer 2

• all i kow is that very little is stored in the form of granules

Question 2

PVH 3 categories

Question 2

ARNI

Answer 2

• falsely raises/ elevates BNP making it unreliables
• so in patients on ARNI, better to look at NT pro BNP

Question 2

Natriuretic peptides

Answer 2

BNP and NT pro BNP

Question 2

gender effects on NP

Answer 2

female gender increase baseline levels of NP

• women naturally have high NP levels without HF… so its unreliable in them

Question 2

NT pro BNP

Answer 2

inactive fragment of the cleaved pro BNP

Question 2

most useful test in patients with suspected HF

Answer 2

Echocardiography

Question 2

ARNI example

Answer 2

sacubitril

Question 2

why is ECG the best for diagnosing HF - 5

Answer 2

- info on chamber volumes - ventricular systolic and diastolic function - wall thickness - valve function - pulmonary HTN

Question 2

according to what is HF classified as

Answer 2

LVEF

Question 2

3 classifications of HF

Answer 2

HFrEF = ≤40% → Reduced EF HFmrEF = 41–49% → Mildly reduced EF HFpEF = ≥50% → Preserved EF

Question 2

normal EF

Answer 2

50 - 70 %

Question 2

management of pts with HFrEF

Answer 2

- ACEi/ARB -beta blocker - MRA - dapagliflozin/ emapgliflozin - loop diuretic for fluid retention (class 1)