Heart Failure & Hypertension

Question 1

What is heart failure?

Answer 1

A clinical syndrome with symptoms in history and signs on examination, caused by cardiac dysfunction

Question 2

What are the two types of heart failure?

Answer 2

Heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF).

Question 3

What is ejection fraction (EF)?

Answer 3

A measure of systolic function, calculated as (Stroke Volume / End Diastolic Volume).

Question 4

What is a normal ejection fraction?

Answer 4

Greater than 50%.

Question 5

What characterizes diastolic dysfunction?

Answer 5

Impaired relaxation and filling, a stiffened heart, with normal contraction and emptying; associated with HFpEF.

Question 6

What characterizes systolic dysfunction?

Answer 6

Impaired contraction and emptying, a weakened heart, abnormal diastole; associated with HFrEF.

Question 7

What EF defines HFpEF?

Answer 7

Left ventricular ejection fraction (LVEF) >40%.

Question 8

What EF defines HFrEF?

Answer 8

Left ventricular ejection fraction (LVEF) <40%.

Question 9

What are the two mechanisms causing venous congestion?

Answer 9

Back pressure and neuro-hormonal activation.

Question 10

How does back pressure lead to venous congestion?

Answer 10

Increased venous pressure reduces the pressure gradient, leading to reduced flow and fluid accumulation.

Question 11

What is a visible sign of pulmonary oedema on chest x-ray?

Answer 11

White, fluffy patches.

Question 12

What symptoms result from fluid accumulation in tissues?

Answer 12

Swelling of legs and lungs.

Question 13

What are the key symptoms of pulmonary oedema?

Answer 13

Breathlessness at rest, orthopnoea, paroxysmal nocturnal dyspnoea, sweating, pallor, cold peripheries, pink frothy sputum.

Question 14

What are common causes of pulmonary oedema?

Answer 14

Sudden fall in cardiac output, increased LV filling pressure, increased pulmonary vascular pressure (e.g., MI, arrhythmia, mitral regurgitation, LV rupture).

Question 15

How is pulmonary oedema treated?

Answer 15

Treat the haemodynamic problem (e.g., reduce back pressure); underlying cause must be addressed.

Question 16

What is the primary treatment for peripheral oedema?

Answer 16

Diuretics (loop and thiazide types).

Question 17

Name examples of loop diuretics.

Answer 17

Bumetanide, furosemide, torsemide.

Question 18

Name examples of thiazide(-like) diuretics.

Answer 18

Bendroflumethiazide, metolazone.

Question 19

What disease-modifying therapies are used for HFrEF?

Answer 19

ACE inhibitors, ARNI (sacubitril-valsartan), beta-blockers, mineralocorticoid receptor antagonists, SGLT2 inhibitors.

Question 20

Why are these therapies effective in HFrEF?

Answer 20

They target neurohormonal pathways that worsen heart failure.

Question 21

What are other advanced treatments for heart failure?

Answer 21

Cardiac resynchronisation therapy, implantable cardioverter defibrillator, left ventricular assist devices, heart transplant.

Question 22

What are the primary systems controlling blood pressure?

Answer 22

Renin-angiotensin-aldosterone system (RAAS), sympathetic nervous system, arginine vasopressin.

Question 23

What percentage of hypertension cases are primary?

Answer 23

90%.

Question 24

What percentage of hypertension cases are secondary?

Answer 24

10%.

Question 25

Why is hypertension harmful?

Answer 25

Causes end-organ damage: microvascular and macrovascular injury.

Question 26

What heart conditions can hypertension cause?

Answer 26

Left ventricular hypertrophy, ischemic heart disease.

Question 27

What brain conditions can hypertension cause?

Answer 27

Stroke (thrombosis, hemorrhage), small vessel disease.

Question 28

How does hypertension affect vasculature?

Answer 28

Atheroma, aneurysm, dissection, increased resistance.

Question 29

How does hypertension affect kidneys?

Answer 29

Glomerular fibrosis, hypertrophy, atheroma.

Question 30

How does hypertension affect the eyes?

Answer 30

Microvascular damage, aneurysms, bleeding, atheroma.

Question 31

What is Conn’s syndrome?

Answer 31

Primary hyperaldosteronism—aldosterone-secreting pathology.

Question 32

How is Conn’s syndrome diagnosed?

Answer 32

Compare renin and aldosterone levels.

Question 33

What is phaeochromocytoma?

Answer 33

Adrenal tumor secreting catecholamines (adrenaline, noradrenaline).

Question 34

How does coarctation of the aorta affect BP?

Answer 34

Higher BP in arms than legs; diagnosed via echocardiography.

Question 35

What condition involves intermittent hypoxia and hypertension?

Answer 35

Sleep apnoea.

Question 36

What is 1st-line treatment for hypertension in patients under 55 or with type 2 diabetes?

Answer 36

ACE inhibitor or ARB.

Question 37

What is 1st-line treatment for hypertension in African/Afro-Caribbean patients without diabetes or >55 years old?

Answer 37

Calcium channel blocker.

Question 38

What is 3rd-line treatment for hypertension?

Answer 38

Add a thiazide or thiazide-like diuretic.

Question 39

What is 4th-line treatment for hypertension?

Answer 39

Add spironolactone or an alpha-blocker.

Question 40

Which calcium channel blockers are dihydropyridines?

Answer 40

Amlodipine, felodipine.

Question 41

Which calcium channel blockers are non-dihydropyridines?

Answer 41

Verapamil, diltiazem.

Question 42

Why must non-dihydropyridine CCBs not be used with beta-blockers?

Answer 42

Both have negative inotropic effects; risk of severe bradycardia and heart block.