Heart failure

Question 1

NYHA classification of heart failure?

Answer 1

Class 1 - no symptoms during normal activity
class 2 - fine at rest, normal activity triggers
class 3 - fine at rest, minor activity triggers
class 4 - unable to do any activity without discomfort

Question 2

clinical features of heart failure?

Answer 2

hypotension, tiredness/dizziness
cold peripheries
oedema
breathlessness

Question 3

2 types of heart failure?

Answer 3

HFrEF (systolic)
HFpEF (diastolic)

Question 4

what is HFrEF?

Answer 4

EF lower than 40%
muscles don’t squeeze properly so fails to pump enough blood the body needs

Question 5

what is HFpEF?

Answer 5

preserved EF
ventricle muscles are stiff or thickened so fail to fill with blood properly

Question 6

ESV and EDV changes in HFrEF and HFpEF?

Answer 6

HFrEF - ESV and EDV increases
HFpEF- EDV decraeses

Question 7

aims of intervention?

Answer 7

offload fluid
- diuretics
increase Stroke volume
- positive ionotrope to increase output
- ACEi to reduce afterload (pressure)
- vasodilator to reduce preload

Question 8

5 pillars of treatment for HFrEF?

Answer 8

ACEi/ARB
Beta blocker
MRA - spironolactone
ARNi - sacubitril and valsartan
SGLT2i - dapagliflozin

Question 9

1st line treatment of HFrEF?

Answer 9

Loop diuretic
ACEi/ARB
MRA

Question 10

specialist treatment?

Answer 10

ivabradine
digoxin
SGLT2i
ARNi
hydralazine with nitrate