Heart Failure

Question 1

Define Heart Failure

Answer 1

syndrome of sub-physiological metabolism as a result of poor tissue perfusion Caused by structural or functional cardiac disease

Question 2

2 systems activated by low perfusion

resulting in positive feedback loop.

Answer 2

Adrenergic

+ Renin-Angiotensin- Aldosterone

Question 3

Adrenerigic and RAAS cardiac effects:

they improve CO in acute response- worsen problem in chronic disease

Answer 3

Vasoconstriction
Increased Rate
Increased Contractility
Retention of Na and H20

(increase 02 demand -> ischaemia, enlarging heart ->ineffective contraction, adrenaline production ->cardiotoxic)

Question 4

Left Heart Failure

definition and causes

Answer 4

Left Systolic Ventricular Dysfunction
Causes: IHD
HTN
Valvular disease

Question 5

Congestive Heart Failure

definition and causes

Answer 5

Right Heart Failure secondary to Pulmonary vascular congestion, secondary to LHF

Question 6

Diastolic Heart Failure

definition and causes

Answer 6

Preserved ventricular ejection fraction >45%

Causes; HTN, elderly, cardiomyopathy

Question 7

Right Heart Failure causes

Answer 7

Causes:
cardiac pathology confined to right heart (tricuspid/ pulmonary valve disease, RV myopathy, RV ishaemia, Left to right shunt)
Pulmonary Pathology (COR PULMONALE) 
-PE
-Pulmonary HTN
-Lung CA
-Fibrosis

Question 8

High Output Cardiac Failure

Answer 8

Structural normal heart with symptoms of heart failure due to abnormal demand

• thyrotoxicosis
• anaemia
• AV shunt
• Beri Beri syndrome
• sepsis
• pregnancy
• pagets

Question 9

Symptoms and Signs of LVSD

Answer 9

Exertional Dysponea
Orthopnoea 
Paroxysmal Noctural Dysponea
Fatigue
Wheeze 
Cough
Haemoptysis
Tachy
Pulsus Alternans 
peripheral cyanosis
cardiomegaly 
s3 Gallop
Basal Creps 
Mitral Regurge
Pleural Effusion

Question 10

COR Pulmonale (right heart failure signs)

Answer 10

Fatigue
Nausea
Wasting
Swollen Ankles
abdominal discomfort
anorexia
breathlessness
raised JVP
smooth hepatomegaly
liver tenderness
pitting oedema 
ascites
tricuspid regurge
tahcy
RV 3rd HS

Question 11

Diagnosis HF

Answer 11

Hx and Exam suggestive of HF
+ Echo showing reduced ventricular function

Once diagnosed must identify cause.

Question 12

Investigations HF

Answer 12

BLoods: FBC, U&E, LFT, Cardiac Enzymes, TFTs, Brain Natriuretic peptide
12 lead ECG
CXR

Echo

(Cardiac MRI
Cardiac catheter +/- biopsy
Nuclear cardiology SPECT/ PET/ RNAngio
Stress Echo)

Question 13

Classsification HF by disability

NY Heart Association

Answer 13

1= No limitation
2= mild limitation
3=marked limitation
4=symptomatic at rest

Question 14

Treatment HF

Answer 14

Stage A (high risk) =Education and lifestyle factors

Stage B(asymptomatic structural) = ACE inhibitor & Beta blocker (first one then 2nd Angi2RB if ACE not suitable)

Stage C (symptomatic) = Add Loop Diuretic
Specialist may also ADD Digoxin/ Spironalactone/ hydralzine and Nitrate/ Valsartan / explore surgical options)

Stage D (refractory) = Inotropes eg. Ivabradine, Heart Transplant, Palliative Care.

Question 15

Stages Heart failure

Answer 15

Stage A = high risk
Stage B =asymptomatic structural
Stage C =symptomatic
Stage D =refractory