Heart Failure

Question 1

define heart failure

Answer 1

a clinical syndrome comprising of dyspnoea, fatigue or fluid retention due to cardiac dysfunction either at rest or on exertion with accompanying neuro-hormonal activation.

Question 2

what increases the risk of heart failure?

Answer 2

> treatment of MI
> aging population
> hypertension
> diabetes
> obesity
> coronary heart disease

Question 3

what are the symptoms of heart failure?

Answer 3

> breathlessness
fatigue
oedema
reduced exercise capacity

Question 4

what are the signs of heart disease?

Answer 4

> oedema
> tachycardia
> raised JVP
> chest crepitation's or effusions
> 3rd heart sound
> displaced or abnormal apex beat

Question 5

why is it usually difficult to diagnose heart failure on clinical grounds?

Answer 5

the signs and symptoms re often non-specific, and patients may only have symptoms.

Question 6

what are the European guidelines for the diagnosis of heart failure?

Answer 6

1. symptoms or signs of heart failure
2. objective evidence of cardiac dysfunction
3. response to therapy

Question 7

what imaging tests can be carried out for heart failure?

Answer 7

> echocardiography
radionuclide ventriculography
MRI
left ventriculography

Question 8

why is echocardiography used the most often?

Answer 8

it is the most practical and does not use radiation

Question 9

what is brain (B-type) natriuretic peptide?

Answer 9

it is an amino acid peptide that can be measured easily in blood and s produced in heart failure.

Question 10

what two potential screening tests are there?

Answer 10

> 12 lead ECG

> BNP

Question 11

why is BNP a good screening test?

Answer 11

> it is highly sensitive to heart failure
stable up to 72hours
bedside testing available
relatively inexpensive

Question 12

what does a low BNP rule out?

Answer 12

heart failure and left ventricular systolic dysfunction

Question 13

what does an elevated BNP indicate?

Answer 13

that an echocardiography and cardiac assessment is needed

Question 14

what sort of structural cardiac abnormally can lead to heart failure?

Answer 14

any severe structural abnormality

Question 15

give some general causes of left ventricular systolic function

Answer 15

> ischaemic heart disease
dilated cardiomyopathy
severe aortic valve disease or mitral regurgitation

Question 16

what does an echocardiography identify and quantify?

Answer 16

> LV systolic dysfunction
> valvular dysfunction
> pericardial effusion/tamponade
> diastolic dysfunction
> left ventricular hypertrophy
> atrial/ventricular shunts
> pulmonary hypertension/right heart dysfunctions

Question 17

why can left ventricular ejection fraction be difficult to quantify accurately by echo?

Answer 17

> quality of images
> experience of the operator
> calculation method
> use of contrast agents
> time consuming to perform accurately

Question 18

what is the normal range for left ventricular ejection fraction?

Answer 18

50-80%

Question 19

what is the range of left ventricular ejection fraction in mild dysfunction?

Answer 19

40-50%

Question 20

what is the range of left ventricular ejection fraction in moderate dysfunction?

Answer 20

30-40%

Question 21

what is the range of left ventricular ejection fraction in severe dysfunction?

Answer 21

<30%

Question 22

in biplane modified Simpsons rule what does the volume of each slice equal?

Answer 22

the area times the thickness

Question 23

what are the pros of MUGA imaging?

Answer 23

> greater reproducibility
centre specific normal range
it is easier to obtain an accurate figure for the LVEF

Question 24

what are the problems with MUGA?

Answer 24

it uses ionising radiation and gives no additional structural information

Question 25

what is left ventricular function an predictor of?

Answer 25

death in hospitalised heart failure patients

Question 26

describe grade one heart failure?

Answer 26

there is no limitation to exercise tolerance and there are no symptoms in usual activity

Question 27

describe grade two heart failure?

Answer 27

there is mild limitation to exercise tolerance and they are comfortable at rest or mild exertion.

Question 28

describe grade three heart failure?

Answer 28

there is moderate limitation to exercise tolerance and they are comfortable only at rest

Question 29

describe grade four heart failure?

Answer 29

there is severe limitation to exercise tolerance and any physical activity brings on discomfort and symptoms occur at rest.