Heart failure

Question 1

What are clinical features

Answer 1

Breathlessness on exertion, fluid retention, fatigue, elevated JVP, 3rd heart sound, displaces apex beat

Question 2

types

Answer 2

HF-REF: systolic problem , EF<50% due to coronary problems e.g. IHD, MI

HF-PEF: diastolic problem, EF>50% due to hypertensive problem meaning ventricle can’t relax properly. e.g. cardiac tamponade, ventricular hypertroph

Question 3

types

Answer 3

HF-REF: systolic problem , EF<50% due to coronary problems e.g. IHD, MI

HF-PEF: diastolic problem, EF>50% due to hypertensive problem meaning ventricle can’t relax properly. e.g. cardiac tamponade, ventricular hypertroph

Question 4

Key investigations

Answer 4

CXR: Kerley B lines, pulmonary oedema
Bloods: has to be raised BNP
ECG: suggests underlying pathology

If BNP or ECG abnormal do an echo.

Question 5

What is the management of (REF) HF?

Answer 5

1. BB and ACEi
2. Add an MRA
3. Add salcubitril/valsartain and stop ACEi. Useful in REF.
4. ICT or ivabridine/CRT.
5. Add digoxin and hydralazine/isosorbide dinitrate.
6. LVAD/heart transplant.

Diuretics for symptom management.

Question 6

What is treatment for HF PEF?

Answer 6

Aldosterone receptor antagonists