Heart Failure

Question 1

what are the two types of heart failure

Answer 1

left ventricular systolic dysfunction (LVSD)

heart failure with preserved ejection fraction (HFPEF – heart contracts okay but doesn’t pump effectively, the heart wont relax properly therefore it cannot fill)

Question 2

what is the most common cause of heart failure

Answer 2

coronary artery disease

Question 3

how many patients die within a year diagnosis of heart failure

Answer 3

30-40% of patients

Question 4

what are the causes of heart failure

Answer 4

• Coronary artery disease
• Hypertension
• Cardiomyopathy
• Valvular heart disease

Question 5

what are aggravating factors of heart failure that are more treatable

Answer 5

• Cardiac arrhythmias such as AF
• Hypertension
• Anaemia
• Infections

Question 6

what is the presentation of heart failure in terms of symptoms

Answer 6

• Very non specific symptoms and signs
• Shortness of breath
• Ankle oedema
• Fatigue

Question 7

what can shortness of breath symptom of heart failure be caused by

Answer 7

• Anaemia
• COPD
• OBESITY
• Rheumatic joints
• Deconiditioning

Question 8

what can the ankle oedema symptom of heart failure be caused by

Answer 8

•	Drainage problems
–	VVs
–	Vein harvesting
–	Lymphoedema
–	DVT
•	Postural effects
•	Drugs
–	amlodipine

Question 9

what can the fatigue symptom of heart failure be caused by

Answer 9

• Anemia
• Sleep disorders
• Stress
• Ageing
• Childcare etc

Question 10

what does the ECG of heart failure look like

Answer 10

• Inferior(pathological) Q waves
• Anterior T waves and ectopics
• Left bundle branch block

Question 11

what does the chest x ray of heart failure look like

Answer 11

• Pulmonary congestion
• Pulmonary oedema
• Enlarged heart

Question 12

what can an echocardiogram show you

Answer 12

• interested in heart valves
• dimensions of the left ventricle and how well it is contracting
• how well the septum is moving
• how the posterior and anterior walls are moving

Question 13

how would a GP diagnose heart failure

Answer 13

• raised BNP

Question 14

what is BNP secreted by

Answer 14

• Secreted by myocardial cells in response to raised left atrial pressure

Question 15

what does BNP do

Answer 15

Promotes natriuresis, vasodilatation

• Inhibits ADH and aldosterone release

Question 16

what levels of BNP can cause heart failure

Answer 16

Levels >100pg/ml (NT PRO-BNP >400 pg/ml) indicate heart disease as likely cause of dyspnoea and fluid retention

Question 17

describe the NICE guideline of treatment for heart failure

Answer 17

1. detailed examination and history

if previous MI

• specialist assessment and doppler echo
• normal echo - heart failure is unlikely
• abnormal echo - systolic dysfunction or diastolic dysfunction

no previous MI

• measure BNP
• less than 100pg/ml then heart failure is unlikely
• greater then 100pg/ml heart failure is likely refer to specialist assessment and doppler echo and so on

Question 18

what is the most common heart failure systolic or diastolic

Answer 18

systolic

Question 19

describe how the body toys to prevent and treat heart failure itself

Answer 19

• either via the sympatho-adrenal activation or by renin-angiotensin activation

Question 20

how does the sympho-adrenal system compensate

Answer 20

• increases inotropic state of the heart
• increases contractile function
• it also can cause redistribution of venous flow
• this leads to ventricular dilation which increases contractile function

Question 21

what blocks the sympho-adrenal system

Answer 21

beta blockers

Question 22

how does the renin angiotensin activation work

Answer 22

• it increases myocardial mass
• this increases contractile function
• all can cause salt and water retention, this increases ventricular dilation which increases contractile function

Question 23

what blocks the renin angiontestine system

Answer 23

• ACE
• ARB
• spironolactone

Question 24

what are the overlying treatments for systolic and diastolic failure

Answer 24

Treat aetiological and aggravating factors

• Treat fluid retention with diuretics

Question 25

how do you treat systolic heart failure

Answer 25

ACE-Is (all grades of heart failure) • ARBs (if ACE-Is cannot be tolerated) • beta-blockers (all grades of heart failure) • spironolactone (NYHA grade III and IV only) • devices – cardiac resynchronization therapy (CRT) – ± ICD • angiotensin receptor neprilysin inhibitor.

Question 26

what is the only thing from systolic heart failure that can work in diastolic heart failure treatments

Answer 26

diuretics

Question 27

what is cardiac resynchronisation therapy

Answer 27

if you have prolonged QRS complex and bad left ventricle which is symptomatic despite therapy in that situation a pacemaker will be implanted and getting the stimulation delay between left and right, this will improve patietns,

Question 28

what is the criteria for a pacemaker

Answer 28

- have to be in sinus rhythm for it to work - LV ejection fraction has to be less than 35% - Sympatomatic - And QRS complex

Question 29

what do you have to have in order to get heart transplant

Answer 29

``` resistant ccf without: – major organ failure – major co-morbidity – psychological disability – severe pulmonary hypertension (heart lung transplant needed) ```

Question 30

what is the prognosis for heart failure

Answer 30

• Prognosis | – 80% 1 year survival

Question 31

describe diastolic heart failure

Answer 31

* Impaired LV filling due to increased chamber stiffness and/or decreased relaxation * More common in women and older people * Responsible for about 50% of heart failure in adults * Prognosis similar to systolic dysfunction * Most patients have elements of systolic and diastolic dysfunction

Question 32

what are the treatments of diastolic heart failure

Answer 32

* Treat underlying cause: esp hypertension * Treat systolic components if picture is mixed * Treat fluid retention * RAS Inhibition, B-blockers: no proven value