heart failure

Question 1

What is heart failure

Answer 1

• Results from structural and/or functional cardiac disorders - usually of gradual onset
  Unable to sustain adequate blood delivery around the body

Question 2

HF epidemiology

Answer 2

0.3-2% population
50% dead at 5 years
10% AF associated

Question 3

aetiology of HF

Answer 3

pump failure - damage has lead to a decrease in contractility (IHD)
overloading - extra workload causes decreased contraction force and delayed relaxation

Question 4

what can cause pump failure in the heart

Answer 4

MI
cardiomyopathy
arrythmias
inflammation
infection

Question 5

what can cause the heart to be overloaded

Answer 5

excessive afterload - high systemic/pulmonary, vascular resistance, valve dysfunction
excessive preload - fluid retention

Question 6

what are some other less common causes of HF

Answer 6

arrythmias
pregnancy
obesity

Question 7

what is acute HF

Answer 7

usually after MI
- cardiac output drops - decompensated
- contractility drops - compensated

Question 8

what is chronic HF

Answer 8

same as acute, but slower onset, pt can remain in compensated HF indefinitely

Question 9

3 clinical features of HF

Answer 9

exercise limitation and fatigue - less blood flow to muscles
SOB - back pressure from heart causes fluid accumulation on lungs
oedema - salt/water retention

Question 10

what are the main causes of symptoms of HF

Answer 10

hypoperfusion and oedema

Question 11

what is hypoperfusion

Answer 11

Impaired flow ahead of heart/chamber affected

Question 12

what does hypoperfusion cause

Answer 12

peripheral vasoconstriction
fatigue
cold extremities
fluid retention
tachycardia/tachypnoea

Question 13

what is oedema inHF

Answer 13

increase in pressure in veins draining to the heart

Question 14

what does right sided oedema cause

Answer 14

peripheral oedema
liver enlargement
raised jugular pressure
fluid retention

Question 15

what does left sided oedema cause

Answer 15

pulmonary oedema
SOB
cough/wheeze

Question 16

how is HF diagnosed

Answer 16

swelling, jugular pressure, lung sounds
natriuretic peptides
ejection fraction
xray/ecg/bp

Question 17

what is HFrEF

Answer 17

HF with reduced ejection fraction - drugs!! (<40%)

Question 18

what is HFpEF

Answer 18

HF with preserved ejection fraction (>50%)

Question 19

what is HFmrEF

Answer 19

HF with mid range ejection fraction (41-50%)

Question 20

how do you treat HF caused by myocardium disease

Answer 20

increasing inotropy

Question 21

how do you treat HF caused by excessive load

Answer 21

reduce pre/after load

Question 22

what is 1st line treatment for HFrEF and what are they used for

Answer 22

loop diuretic - furosemide - decreased preload and oedema
ACEi - ramipril - reduce pre/after load
B blockers - bisoprolol - reduce pre/after load
aldosterone antagonists - spironolactone- reduce pre/after load and LVH risk

Question 23

which medicines can be added on to control HF

Answer 23

digoxin - myocardial stimulation
isosorbide dinitrate - preload
hydralazine - afterload
ARNI - pre/after load
SGLT2 - pre/after load

Question 24

which 3 types of diuretic can be used in HF

Answer 24

thiazide - bendro 5mg max for mild HF
loop- mainstay
metolazone - atypical for resistant AF (2.5-5mg stat or every 2-3 days)

Question 25

what are ARNIs and how do they work

Answer 25

angiotensin receptor neprilysin inhibitors - valsartan ARB and sacubitril neprilysin inhibitor - stops degradation of natriuretic peptide

Question 26

ESC 1st line for HF guidelines

Answer 26

ACEi/ARNI B blocker MRA (spironolactone) SGLT2 loop diuretic

Question 27

what is starlings law of the heart

Answer 27

The greater the volume of blood entering the heart at diastole, the greater the volume of blood ejected during systolic contraction

Question 28

what are the 4 mechanisms of compensation in HF

Answer 28

cardiac enlargement arterial constriction increased sympathetic drive salt/water retention

Question 29

how does cardiac enlargement work in HF compensation

Answer 29

- Cardiac muscle is stretched from increased residual volume after contraction - impairment as a pump - Left ventricular hypertrophy (LVH) - enlargement and thickening of left ventricular wall

Question 30

how does arterial constriction work in HF compensation

Answer 30

- Arteries constrict when blood output is reduced to direct blood to essential organs

Question 31

how does increased sympathetic drive work in HF compensation

Answer 31

Reduced tissue perfusion activates sympathetic nervous system via baroreceptors, Exposes heart to catecholamines with positive inotropic and chronotropic effects - increase force and rate of contraction (noradrenaline, angiotensin, aldosterone)

Question 32

how does salt/water retention work in HF compensation

Answer 32

reduced cardiac output = decreased renal perfusion renin release, aldosterone I and II produced = aldosterone increased - increases pre-load via water retention at renal tubule - atrial natriuretic peptide release

Question 33

what symptoms are associated with class I of the new York heart associations classification of HF symptoms

Answer 33

no limitations

Question 34

what symptoms are associated with class II of the new York heart associations classification of HF symptoms

Answer 34

slight limitation comfortable at rest ordinary activity = fatigue, palpitation, angina

Question 35

what symptoms are associated with class III of the new York heart associations classification of HF symptoms

Answer 35

marked limitation on activity still comfortable at rest less than ordinary activity = symptoms

Question 36

what symptoms are associated with class IV of the new York heart associations classification of HF symptoms

Answer 36

inability to do anything without discomfort symptoms still present even at rest