Heart Failure

Question 1

What is the classification of Heart failure?

Answer 1

Heart failure with reduced ejection fraction <40%
HF with mildly reduced EF 41-49%
HF with preserved ejection fracture >50%

Question 2

What is the NYHA- (New York Heart Association)?

Answer 2

To categorise severity of HF

Class 1- No limitation
Class 2- Slight limitation of ordinary activity
Class 3- Significant limitation- only comfortable at rest
Class 4- Severe limitations, symptoms at rest, often bedbound

Question 3

What are clinical features?

Answer 3

SoB worse on exertion
Paroxysmal Nocturnal Dyspnoea
Orthopnoea
Oedema- ankles, weight gain
Tired all the time
Elevated JVP

Question 4

What are investigations for HF?

Answer 4

1) Measure NT Pro-BNP
- >2000= high, specialist assessment and ECHO within 2 weeks
- 400-2000- specialist assessment and ECHO within 6 weeks
- <400 HF unlikely

BNP can falsely be raised in obesity, afro-caribbean, ACEi/BB/ARBs
2) ECHO

CXR
- Alveolar oedema e.g. bat wing opacification
- Kerley B lines
- Cardiomegaly
- Dilated upper lobe vessels
- Effusions

Question 5

What is the management of HFrEF?

Answer 5

1) ACEi and BB
- no ACEi if ?valve disease
- ARB if ACEi not tolerated
2) Ongoing symptoms- spironolactone or eplerenone
3) Specialist management

Question 6

What is the specialist management of HFrEF?

Answer 6

Ivabradine- if EF <35% and in sinus rhythm with HR >75
Sacubitril-valsartan if EF <35% (stop ACEi/ARB)
SGLT2 inhibitor
Digoxin- consider in sinus or esp if AF
Hydralazine+ Nitrate- if afro Caribbean
Cardiac Resynchronisation therapy- symptomatic benefit esp if wide QRS

Question 7

What is the management of HFpEF?

Answer 7

Diuretics for symptomatic relief
No benefit with ACEi/BB
SGLT2 inhibitors recommended by NICE