Heart Failure

Question 1

Define Heart Failure

Answer 1

State in which the heart fails to maintain an adequate circulation for the needs of the body despite an adequate filling pressure

Question 2

Conditions that affect/ impair which 3 things can lead to impaired cardiac function

Answer 2

• Functioning muscle
• Chamber size
• One way valves

Question 3

List 7 possible causes of Heart failure

Answer 3

• Coronary artery disease (Most common)
• Hypertension (Increased afterload on ventricle)
• Aortic stenosis (Increased afterload on ventricle)
• Cardiomyopathies (Hypertrophy)
• Pericardial disease
• Arrhythmia
• Elevated demand on Cardiac output (Rare)

Question 4

What is the Ejection Fraction, EF?

How much is normal?

Answer 4

Percentage of EDV of blood pumped out of heart per beat (SV/EDV *100)

50%-70%

Question 5

What are 4 things that influence the Cardiac Output

Answer 5

Pre load (EDV)
After load (Total peripheral resistance)
Myocardial Contractility
Heart rate

Question 6

What are 2 causes of Heart failure

Answer 6

Inability of heart to fill properly (HFpEF/ diastolic dysfunction)

Inability of heart muscle to contract properly (HFrEF systolic dysfunction)

Question 7

In reference to HFpEF, explain why a normal Ejection Fraction does not rule out Heart Failure

Answer 7

• Less filling of heart, so less blood pumped out

- Fraction of SV/ EDV is normal, but CO is still lower than normal

Question 8

What are 2 mechanisms of HFpEF

Answer 8

• Ventricle chambers too stiff
• Ventricle walls thickened

(Reduced capacity of ventricle for blood)

Question 9

What are 3 mechanisms of HFrEF

Answer 9

• Ventricle muscle walls thin/ fibrosed
• Ventricle chambers enlarged
• Abnormal/ uncoordinated myocardial contraction

(Can’t pump with enough force for a given EDV)

Question 10

What is the most common type of heart failure

Answer 10

HFrEF

Question 11

Heart failure can affect both sides of heart. Which side is most commonly affected?

Answer 11

Left side (Often leads to right side failure as well)

Question 12

How can left sided heart failure cause right sided heart failure

What do you call hear failure in both sides

Answer 12

Raised pulmonary arterial pressure leading to additional right sided heart failure

Congestive heart failure

Question 13

What’s the most common cause of Right sided heart failure

Answer 13

Left sided heart failure

Question 14

Name 3 physiological mechanisms used to try and correct a falling cardiac output in heart failure

What is the outcome of these?

Answer 14

(Neurohormonal effects);

• SNS (increased contractility, vasoconstriction, tachycardia)
• RAAS
• Increased ADH secretion

Cause a failing heart to work harder, further reducing cardiac output)

Question 15

Other than oedema, list 6 symptoms of LV Heart Failure

Answer 15

• Fatigue/ lethargy
• Breathlessness on exertion
• Orthopnea (Shortness of breath when lying flat)
• Paroxysmal nocturnal dyspnoea (Severe SOB and coughing at night)
• Basal pulmonary crackles
• Cardiomegaly (Displaced apex beat indicated enlarged LV)

Question 16

Other than oedema, list 4 symptoms of RV Heart Failure

Answer 16

• Fatigue/ lethargy
• Breathlessness
• Raised jugular venous pressure
• (Possible) Tender, smooth enlarged liver (liver congestion)

Question 17

Compare the types of Oedma caused by RV and LV heart failure

Answer 17

RV: Peripheral oedema
LV: Pulmonary oedema

Question 18

Impaired ventricle contractility leads to Atria stretching. What 2 molecules are released as this happens?

What are 3 of their effects?

Answer 18

Natriuretic peptides, ANP and BNP

Oppose the opposite neurohormonal effects;

• Vasodilation
• Inhibit renin secretion
• Natriuresis (los of Na and H2O at kidneys)

(Beneficial effects are not usually sufficient to overcome the deteriorating neurohormonal effects)

Question 19

Which Natriuretic Peptide is used to assess likelihood of Heart failure?

What other heart condition raises those substance’s blood concentration?

Answer 19

BNP (Normal varies with age/ gender)

Atrial fibrillation (Can triple BNP)

Question 20

Identify 1 symptomatic treatment for Heart failure, and 5 prognostic treatments

Answer 20

• Furosemide (Immediate Venodilator)
• Beta blockers
• Spironolactone
• ACE inhibitors/ Angiotensin II receptor blockers
• Biventricular pacemaker
• Diuretics

Question 21

Name 4 investigations used to diagnose heart failure

Answer 21

• ECG
• CXR
• Transthoracic Echocardiogram
• Blood tests (FBC, BNP, NTpro-BNP, U&Es)

Question 22

Other than BNP and NTpro-BNP, describe 3 blood tests used to investigate heart failure

Answer 22

1. FBC;
   - Often anaemic in heart failure
2. U&Es;
   - Renal function deteriorates in heart failure
3. LFTs;
   - May be elevated due to hepatic congestion