Heart Failure

Question 1

What is heart failure?

Answer 1

Clinical syndrome of circulatory insufficiency, resulting from any structural or functional cardiac disorder that impairs ventricular ability to fill with/eject blood

Question 2

How does the prevalence of heart failure change with age?

Answer 2

Increases as age increases, mostly affecting elderly patients

Question 3

What is the most common cause of heart failure?

Answer 3

Coronary artery disease (CAD)

Question 4

What are other causes of heart failure?

Answer 4

• Hypertension
• Valve disease
• Alcohol
• A-fib

Question 5

What are the four important risk factors for heart failure?

Answer 5

• Hypertension
• Diabetes
• Metabolic syndromes
• Atherosclerotic disease

Question 6

What is the first step in heart failure pathophysiology?

Answer 6

Decreased cardiac output due to reduced diastolic filling

Question 7

What systems are activated due to decreased cardiac output?

Answer 7

• RAAS system
• Sympathetic nervous system

Question 8

What does the renin-angiotensin-aldosterone system (RAAS) activation lead to?

Answer 8

• Vasoconstriction
• Sodium and water absorption in renal tubules
• Aldosterone release
• Direct detrimental myocardium effects (hypertrophy and fibrosis)

Question 9

What are the effects of AT2 binding to the AT1 receptor?

Answer 9

• Vasoconstriction
• Sodium and water retention
• Aldosterone release
• Myocardial effects (hypertrophy and fibrosis)

Question 10

What are the consequences of renal salt and water retention in heart failure?

Answer 10

• Pulmonary congestion
• Systemic congestion
• Adverse left ventricular remodelling

Question 11

What are the two main effects of sympathetic nervous system (SNS) activation in heart failure?

Answer 11

• Cardiac remodelling
• Arrhythmias

Question 12

What is the classification of heart failure based on ejection fraction?

Answer 12

• HFrEF (reduced ejection fraction): LVEF of 40% or less
• HFmrEF (mildly reduced ejection fraction): LVEF between 41-49%
• HF-PEF (preserved ejection fraction): LVEF of 50% or more

Question 13

What distinguishes acute heart failure from chronic heart failure?

Answer 13

• Acute: New presentation
• Chronic: Deterioration or decompensation of existing heart failure

Question 14

What tool is used to assess symptomatic severity in heart disease?

Answer 14

New York Heart Association (NYHA) tool

The NYHA classification system categorizes heart disease into four classes based on physical activity limitations and symptoms.

Question 15

What does Class I indicate in the NYHA classification?

Answer 15

No limitation

Individuals in Class I have no symptoms and can perform physical activities without restriction.

Question 16

What characterizes Class II in the NYHA classification?

Answer 16

Slight limitation of ordinary physical activity

Symptoms like fatigue, shortness of breath (SOB), and palpitations may occur with ordinary activities.

Question 17

What symptoms are associated with Class III in the NYHA classification?

Answer 17

Marked limitation with moderate heart disease

Patients experience undue fatigue, SOB, and palpitations even with less than ordinary exertion.

Question 18

What defines Class IV in the NYHA classification?

Answer 18

Severe heart disease with symptoms at rest

Individuals have constant fatigue, discomfort, and symptoms even without exertion.

Question 19

What are common symptoms of right-sided heart failure?

Answer 19

Peripheral edema, ascites, hepatosplenomegaly, weight gain, elevated JVP

These symptoms may include bloating, early satiety, and abdominal pain.

Question 20

What symptoms are indicative of left-sided heart failure?

Answer 20

Pulmonary edema, dry cough, pink sputum, tachypnea, cyanosis, restlessness

These symptoms reflect fluid accumulation in the lungs.

Question 21

List some non-specific symptoms of heart failure.

Answer 21

• Fatigue
• Lethargy
• Dyspnea
• Palpitations
• Presyncope/syncope

These symptoms can vary widely among patients with heart failure.

Question 22

What investigations are commonly performed for heart failure diagnosis?

Answer 22

• 12-lead ECG
• Blood tests (U&Es, eGFR, FBC, iron studies, thyroid function tests, LFTs, HbA1c)
• Urinalysis
• Lung function tests
• NT-pro-BNP level
• Imaging tests (Echocardiogram, Cardiac CT/MRI, nuclear imaging, invasive coronary angiography, chest x-ray)

These tests help assess heart function and identify underlying causes of symptoms.

Question 23

What NT-pro-BNP level suggests a diagnosis of heart failure?

Answer 23

400 no/L or more

Elevated NT-pro-BNP levels are indicative of heart failure and help in diagnosis.

Question 24

True or False: Anaemia and low lymphocyte count are markers of good prognosis in heart failure.

Answer 24

False

These conditions are associated with poor prognosis in heart failure patients.

Question 25

What is the role of a Beta-blocker in heart failure management?

Answer 25

Relax blood vessels, reduces stress on heart, improve heart pumping ability ## Footnote Beta-blockers are commonly used in heart failure to enhance cardiac output and reduce workload on the heart.

Question 26

What does ARNI stand for and what is its function?

Answer 26

Angiotensin Receptor-Neprilysin Inhibitor ## Footnote An example of ARNI is Entresto, which contains valsartan (an ARB) and sacubitril (a neprilysin inhibitor).

Question 27

Which medication blocks the effect of aldosterone?

Answer 27

Mineralocorticoid receptor antagonist (MRA) ## Footnote An example of an MRA is Spironolactone, which helps to reduce fluid retention in heart failure patients.

Question 28

Fill in the blank: _______ inhibitors increase the excretion of excess glucose in urine.

Answer 28

SGLT2 ## Footnote SGLT2 inhibitors like Dapagliflozin and Empagliflozin also help to protect renal function and lower blood pressure.

Question 29

What are some management strategies for all types of heart failure?

Answer 29

* Loop diuretic * Consider amiodarone * Anticoagulants * Up-to-date vaccinations * Discuss contraception and pregnancy * Wellness checks and screening for depression * Lifestyle advice * General monitoring * Cardiac rehab * Palliative care ## Footnote These strategies are essential for comprehensive heart failure management.

Question 30

What is the purpose of coronary revascularisation in heart failure treatment?

Answer 30

To improve blood flow to the heart ## Footnote This intervention is indicated for patients with significant coronary artery disease contributing to heart failure.

Question 31

True or False: Cardiac resynchronisation therapy (CRT) is used for patients with severe refractory symptoms.

Answer 31

True ## Footnote CRT is particularly helpful for patients with specific types of heart failure and electrical conduction issues.

Question 32

When might transplantation be considered in heart failure patients?

Answer 32

If patient has severe refractory symptoms or cardiogenic shock ## Footnote Transplantation is a last resort for patients who do not respond to other treatments.

Question 33

What should be included in general monitoring for heart failure patients?

Answer 33

* Functional capacity * Fluid status * Cardiac rhythm * Medication review * Renal function ## Footnote Regular monitoring helps in managing heart failure effectively and adjusting treatments as necessary.

Question 34

Which patients may require Hydralazine plus Nitrate treatment?

Answer 34

Patients who cannot tolerate ARNI/ACEI/ARB or are black race with symptoms despite standard therapy ## Footnote This combination is an alternative treatment strategy for specific populations in heart failure management.

Question 35

What is the function of Ivabradine in heart failure treatment?

Answer 35

Used when symptoms persist despite standard therapy and heart rate is ≥70 bpm ## Footnote Ivabradine specifically targets heart rate reduction to alleviate symptoms.