5 Markers

Question 1

Explain the pathophysiology of HFrEF (5 marks).

Answer 1

1. ↓ Contractility due to myocardial damage.
2. ↓ Cardiac output.
3. Neurohormonal activation (RAAS, SNS, ADH).
4. Vasoconstriction + fluid retention.
5. Ventricular remodelling worsens HF.

Question 2

Describe the neurohormonal model of heart failure (5 marks).

Answer 2

1. ↓ CO → ↓ renal perfusion.
2. RAAS activation → Ang II + aldosterone.
3. SNS activation → ↑ HR & vasoconstriction.
4. Chronic activation → fibrosis & remodelling.
5. HF drugs block these pathways.

Question 3

Explain the difference between HFrEF and HFpEF (5 marks).

Answer 3

1. HFrEF: EF ≤40%.
2. HFpEF: EF ≥50%.
3. HFrEF = systolic dysfunction.
4. HFpEF = diastolic dysfunction.
5. HFpEF treatment mainly symptomatic (diuretics + SGLT2i).

Question 4

Describe typical symptoms and signs of heart failure (5 marks).

Answer 4

1. Dyspnoea.
2. Orthopnoea/PND.
3. Fatigue.
4. Peripheral oedema & raised JVP.
5. Lung crackles & hepatomegaly.

Question 5

Explain how ACE inhibitors improve outcomes in HF (5 marks).

Answer 5

1. ↓ Ang II.
2. ↓ Vasoconstriction.
3. ↓ Aldosterone.
4. ↓ Remodelling.
5. Improve survival & symptoms.

Question 6

Describe the mechanism and benefits of beta-blockers in HF (5 marks).

Answer 6

1. Block β1 receptors.
2. ↓ HR & O2 demand.
3. ↑ Diastolic filling.
4. ↓ Arrhythmias.
5. ↓ Mortality.

Question 7

What are the four pillars of HFrEF therapy and why? (5 marks).

Answer 7

1. ACEI/ARB/ARNI.
2. Beta-blocker.
3. MRA.
4. SGLT2 inhibitor.
5. All reduce mortality & hospitalisation.

Question 8

Explain the role of SGLT2 inhibitors in HF (5 marks).

Answer 8

1. Mild natriuresis.
2. ↓ Preload.
3. Cardio-renal protection.
4. ↓ Hospitalisation & CV death.
5. Work in all EF types.

Question 9

Describe when digoxin is used in HF (5 marks).

Answer 9

1. Not first-line.
2. Symptom relief in HFrEF.
3. Useful in AF for rate control.
4. ↓ Hospitalisations.
5. No mortality benefit.

Question 10

What is acute decompensated HF and how is it managed? (5 marks).

Answer 10

1. Sudden HF worsening.
2. Causes: infection, MI, arrhythmia.
3. Give IV diuretics.
4. Oxygen if hypoxic.
5. Monitor UO, weight, renal function.

Question 11

Why is aldosterone harmful in HF? (5 marks).

Answer 11

1. Na+/water retention.
2. ↑ Preload.
3. Cardiac fibrosis.
4. Hypokalaemia → arrhythmias.
5. MRAs block these effects.

Question 12

Describe investigations used in diagnosing HF (5 marks).

Answer 12

1. NT-proBNP.
2. Echocardiogram.
3. ECG.
4. CXR.
5. Bloods (U&E, FBC, TFT, HbA1c).

Question 13

Why does HF cause breathlessness? (5 marks).

Answer 13

1. ↑ LVEDP.
2. Pulmonary venous congestion.
3. Interstitial oedema.
4. ↓ Lung compliance.
5. Impaired gas exchange.

Question 14

Explain how diuretics improve symptoms in HF (5 marks).

Answer 14

1. ↑ Na+/water excretion.
2. ↓ Plasma volume.
3. ↓ Preload.
4. ↓ Pulmonary congestion.
5. Symptom relief only.

Question 15

Why is ivabradine used in HF? (5 marks).

Answer 15

1. Blocks If channels.
2. ↓ HR without ↓ BP.
3. For HR ≥75 in sinus rhythm.
4. Used when BB not enough.
5. ↓ Hospitalisations.