Heart Faure Classification System And BNP i

Question 1

What is the NYHA class 1?

Answer 1

No limitations

Question 2

What is the NYHA class II?

Answer 2

Slight limitation where normal activit causes fatigue

Question 3

What is the NYHA class III?

Answer 3

Marked limitation but comfort AT rest

Question 4

What is the NYHA class IV?

Answer 4

Inability to carry any activity without discomfort and symptoms AT REST

Question 5

BNP level for referral in 6 weeks?

Answer 5

400-2,000

Question 6

BNP referral for urgent referral in 2 weeks?

Answer 6

Over 2,0000

Question 7

BNP level for heart failure?

Answer 7

OVER 400

Question 8

What is the management of heart failure?

Answer 8

ACE inhibitor and beta blocker

Question 9

What is alternative to ACE-I or ARB for heart failure?

Answer 9

Hydralazine/isabradine which is a vasodilator that reduces peripheral resistance, ideal for African patients

Salcubitril/valsartan combination of Salcubitril neprilysin inhibtiors and ARB

Question 10

What improves mortality in diastolic heart failure?

Answer 10

No medication

Question 11

What improves mortality in reduced ejection fraction?

Answer 11

BASH
Beta blockers
ACE inhibitors/ARB
Spironolactone
Hydralazine

Question 12

What is the criteria for changing ACE inhibitor?

Answer 12

ACE inhibitors typically cause a small rise in creatinine. It must be MORE than 30% or FALL in GEFR of 25% to change.

Question 13

When should assessment of renal function of ACE inhibitor be performed with change in enzymes?

Answer 13

Repeat blood test in 1-2 weeks

Question 14

What medication should be added for reduced ejection fraction with persisting symptoms for ACE and beta blocker?

Answer 14

Spironolactone or eplerenone

Question 15

What medication should be added for reduced ejection fraction with persisting symptoms for ACE and beta blocker?

Answer 15

Spironolactone or SGLT2
SGLT2 inhibitors are started earlier, and is especially for diabetics or CKD

Spironolactone is further down the line for those with low potassium.

Question 16

What medication should be added ideally for Afro-Carribean patients with persisting symptoms for ACE and beta blocker?

Answer 16

Hydralasaline and nitrate

Question 17

What medication should be added ideally for atrial fibrillation patients with persisting symptoms for ACE and beta blocker?

Answer 17

Digoxin

Question 18

What is a poor prognostic factor for heart failure?

Answer 18

Pulsus alter and indicating poor left ventiruclar function

Question 19

Which drug causes gum hypertrophy?

Answer 19

Amlodipine Non-DHP CCB

Question 20

Which drug can cause chest pain and weakness as side effect?

Answer 20

Doxazosin

Question 21

Which drug causes constipation and headache?

Answer 21

Indapamide

Question 22

What should be added if a patient has normal bP but ankle oedema?

Answer 22

Loop diuretics for fluid overload relief.

Question 23

Beta blocker and CCB combination for heart failure?

Answer 23

Bisoprolol and Felodipine

-> must be dihydropyridine to avoid additive risk of bradycardia and AV block but this is generally contraindicated for reduced ejection fraction. The only scenario a CCB hound be present if a patient needs it for hypertension.

Question 24

Causes of high output heart fialure

Answer 24

Less common ad caused by:
Anaemia
Pregnancy
Hyperthyroidism
Thiamine deficiency
Paget’s disease
Arteriovenous malformation

Question 25

Causes of low output heart fialure?

Answer 25

Primary issue with the heart

Question 26

What is acute heart failure (AHF)?

Answer 26

A life-threatening emergency characterized by the sudden onset or worsening of heart failure symptoms.

Question 27

What is de-novo AHF?

Answer 27

AHF without a past history of heart failure.

Question 28

What percentage of AHF cases are decompensated AHF?

Answer 28

66-75%.

Question 29

At what age does AHF usually present?

Answer 29

After the age of 65 years.

Question 30

What is a major cause of unplanned hospital admission in patients over 65?

Answer 30

Acute heart failure (AHF).

Question 31

What usually causes AHF?

Answer 31

Reduced cardiac output due to functional or structural abnormalities.

Question 32

What causes de-novo heart failure?

Answer 32

Increased cardiac filling pressures and myocardial dysfunction due to ischaemia.

Question 33

What can reduced cardiac output lead to?

Answer 33

Hypoperfusion and pulmonary oedema.

Question 34

List some less common causes of de-novo AHF.

Answer 34

* Viral myopathy * Toxins * Valve dysfunction

Question 35

What are the most common precipitating causes of acute AHF?

Answer 35

* Acute coronary syndrome * Hypertensive crisis * Acute arrhythmia * Valvular disease

Question 36

What symptoms are typically presented in patients with decompensated heart failure?

Answer 36

Signs of fluid congestion, weight gain, orthopnoea, and breathlessness.

Question 37

How are patients with heart failure broadly characterized?

Answer 37

Based on whether they present with or without hypoperfusion and fluid congestion.

Question 38

What is a challenging scenario in managing AHF?

Answer 38

Patients with hypotension (e.g. < 85 mmHg) or cardiogenic shock.

Question 39

What treatments may exacerbate hypotension in AHF?

Answer 39

Loop diuretics and nitrates.

Question 40

What inotropic agent should be considered for severe left ventricular dysfunction?

Answer 40

Dobutamine.

Question 41

What vasopressor agent is used if there is insufficient response to inotropes?

Answer 41

Norepinephrine.

Question 42

What is a common result of left ventricular failure?

Answer 42

* Pulmonary oedema * Dyspnoea * Orthopnoea * Paroxysmal nocturnal dyspnoea * Bibasal fine crackles

Question 43

What is low-output heart failure?

Answer 43

Occurs when cardiac output is reduced due to a primary problem with the heart.

Question 44

What are common causes of high-output heart failure?

Answer 44

* Anaemia * Arteriovenous malformation * Paget's disease * Pregnancy * Thyrotoxicosis * Thiamine deficiency (wet Beri-Beri)

Question 45

What is the difference between systolic and diastolic dysfunction?

Answer 45

Systolic dysfunction involves reduced ejection fraction, while diastolic dysfunction involves impaired filling of the heart.

Question 46

List some causes of systolic dysfunction.

Answer 46

* Ischaemic heart disease * Dilated cardiomyopathy * Myocarditis * Arrhythmias

Question 47

List some causes of diastolic dysfunction.

Answer 47

* Hypertrophic obstructive cardiomyopathy * Restrictive cardiomyopathy * Cardiac tamponade * Constrictive pericarditis

Question 48

What are some conditions that increase BNP levels?

Answer 48

* Left ventricular hypertrophy * Ischaemia * Tachycardia * Right ventricular overload * Hypoxaemia (including pulmonary embolism) * GFR < 60 ml/min * Sepsis * COPD * Diabetes * Age > 70 * Liver cirrhosis ## Footnote BNP (B-type natriuretic peptide) levels are often used as a biomarker for heart failure and other cardiovascular conditions.

Question 49

What are some factors that decrease BNP levels?

Answer 49

* Obesity * Diuretics * ACE inhibitors * Beta-blockers * Angiotensin 2 receptor blockers * Aldosterone antagonists ## Footnote Medications and conditions that may reduce BNP levels can influence the assessment of heart failure.