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1
Q

Define what heart failure is

A

A clinical syndrome compromising of dyspnoea, fatigue or fluid retention due to cardiac dysfunction, either at rest or exertion, with accompanying neurohormonal activation

2
Q

Why is a diagnosis of a patient with just ‘heart failure’ never made clinically?

(although its always talked about as a diagnosis)

A

Heart failure is not a final diagnosis and the term should be qualified by the underlying structural abnormality and cause

Basically - Heart failure is not a diagnosis, but an effect of something else like LVSD due to IHD

3
Q

How common is heart failure in the UK?

A

1-2% of UK population

4
Q

What are risk factors for heart failure?

A

Age
Sex*

Hypertension 
Diabetes 
CHD 
Obesity
Hyperlipoproteinaemia (HLP) 

Previous Acute MI

5
Q

How does risk of heart failure change with sex?

A

At younger ages, it is more common in men but at older ages, more common in women

6
Q

What is the general prognosis for heart failure?

A

Poor:
30-40% mortality at 1 year

Worse than cancer of breast, uterus, prostate & bladder

Depends on severity^

7
Q

Many patients who present to A&E with HF are re-admitted again after discharge

What are the rates of readmission?

A

10% HF patients readmitted within 1 month of discharge

50% HF patients readmitted over 3 months

8
Q

One of the main problems to the NHS of heart failure is the length of hospital stays by patients with it

What is the only ‘common’ condition that generally requires a greater stay at hospital?

A

Stroke

9
Q

What are the typical symptoms of Heart failure?

A

Breathlessness
Fatigue
Oedema
Reduced exercise capacity

10
Q

What is the most common symptom for which people are admitted for heart failure?

A

Acute breathlessness

11
Q

What are the signs of Heart failure?

A
Peripheral oedema 
Tachycardia 
Raised JVP 
Chest crepitations or effusions 
3rd heart sound S3 
Displaced/abnormal apex beat
12
Q

Summarise the investigative imaging techniques that may be used for HF

A

ECG
CXR
ECHO

Coronary angiography (or CTCA)

Radionucleotide scan
Left ventriculogram
Cardiac MRI

13
Q

Summarise the non-imaging investigative techniques for HF

A

BNP

Full blood count 
Fasting blood glucose 
Serum urea & electrolytes 
Urinalysis 
Thyroid function
14
Q

How would a CXR indicate heart failure?

A

Enlarged heart shadow

Pulmonary oedema

15
Q

What is needed to make a diagnosis of Heart failure?

A

Symptoms / signs

Objective evidence of cardiac dysfunction

Response to therapy (diuretics) - in doubtful cases

16
Q

How would an ECG indicate heart failure?

A

ECG can show LVSD (left vent systolic dysfunction) which is a cause of HF

90-95% sensitive

17
Q

What is BNP and how is testing for it useful?

A

Brain (b type) natriuretic peptide

Levels of this amino acid are elevated in the blood by heart failure

Potential screening test for HF, but is not routinely done clinically

18
Q

An elevated BNP level indicates HF, however, more investigation is needed before heart failure can be confirmed

Why?

A

BNP levels can be elevated due to:

  • A fib
  • Elderly
  • Valve disease

ECHO/cardiac assessment needed if levels are high

19
Q

Summarise the investigative route for a patient who has presented with suspected HF

A

History - symptoms

Examination - signs

ECG

(BNP sometimes)

ECHO

20
Q

Summarise the causes of HF

A

LVSD

VHD

Pericardial constriction or effusion

LVDD / HF with preserved systolic function / HF with normal Ejection fraction

Cardiac arrhythmias: tachy or brady

Myocardial ischaemia/infarction (usually via LVSD)

Restrictive cardiomyopathy: eg amyloid, HCM

Right ventricular failure: primary or secondary to pulmonary hypertension

21
Q

LVSD is the main cause of heart failure

What can cause the left ventricle to pump ineffectively?
LVSD

A

Ischaemic heart disease (usually MI)

Severe Aortic valve disease or mitral regurgitation

Dilated cardiomyopathy (DCM):
- umbrella term for all other causes that aren't IHD or lesion (valve) related
22
Q

What causes of LVSD are covered under DCM?

A
Inherited DCM
Toxins 
Infection 
End stage hypertrophic cardiomyopathy 
End stage arrhythmic RV cardiomyopathy 
Systemic disease 
Muscular dystrophies 
Peri-partum cardiomyopathy 
Hypertension 
Isolated non-compaction 
Tachycardia related cardiomyopathy 
RV pacing induced cardiomyopathy
23
Q

What sort of infections can cause DCM?

A
Acute myocarditis 
Chronic DCM 
HIV 
Chaga's disease 
Lyme's disease
24
Q

Why is Echocardiography a necessary test for a patient with suspected HF?

A

ECHOs allow identification of:

LV systolic dysfunction
Valvular dysfunction
Pericardial effusion / tamponade
Diastolic dysfunction
LVH
Atrial/ventricular shunts / complex congenital heart defects
Pulmonary hypertension / right heart dysfunction