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Questions and Answers
What is the primary characteristic of heart failure?
What is the primary characteristic of heart failure?
Which of the following is the most common cause of heart failure worldwide?
Which of the following is the most common cause of heart failure worldwide?
What type of heart failure is most commonly seen in Zambia?
What type of heart failure is most commonly seen in Zambia?
Which of the following is NOT considered a type of cardiomyopathy associated with heart failure?
Which of the following is NOT considered a type of cardiomyopathy associated with heart failure?
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What role do compensatory mechanisms play in heart failure?
What role do compensatory mechanisms play in heart failure?
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Which condition is a common cause of right heart failure?
Which condition is a common cause of right heart failure?
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Which physiological change does not occur in heart failure?
Which physiological change does not occur in heart failure?
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What factor is least likely to contribute to the pathophysiology of heart failure?
What factor is least likely to contribute to the pathophysiology of heart failure?
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What characterizes acute heart failure (AHF)?
What characterizes acute heart failure (AHF)?
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Which condition is most commonly associated with left ventricular systolic dysfunction (LVSD)?
Which condition is most commonly associated with left ventricular systolic dysfunction (LVSD)?
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What is the main difference between heart failure with reduced ejection fraction (HFREF) and heart failure with preserved ejection fraction (HFPEF)?
What is the main difference between heart failure with reduced ejection fraction (HFREF) and heart failure with preserved ejection fraction (HFPEF)?
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Which NYHA classification is associated with symptoms present at rest?
Which NYHA classification is associated with symptoms present at rest?
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Diastolic heart failure is commonly associated with which demographic?
Diastolic heart failure is commonly associated with which demographic?
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Which investigation is most useful for assessing cardiac chamber dimensions and function?
Which investigation is most useful for assessing cardiac chamber dimensions and function?
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What does an electrocardiogram primarily help identify in heart failure patients?
What does an electrocardiogram primarily help identify in heart failure patients?
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Which of the following findings is NOT indicative of pulmonary congestion on a chest X-ray?
Which of the following findings is NOT indicative of pulmonary congestion on a chest X-ray?
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What is the primary purpose of stress echocardiography in assessing myocardium?
What is the primary purpose of stress echocardiography in assessing myocardium?
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Which imaging technique uses gadolinium for delayed enhancement to assess myocardial viability?
Which imaging technique uses gadolinium for delayed enhancement to assess myocardial viability?
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Which medication should be considered for all patients with left ventricular systolic dysfunction?
Which medication should be considered for all patients with left ventricular systolic dysfunction?
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What is the role of ambulating 24-hour ECG monitoring in heart failure patients?
What is the role of ambulating 24-hour ECG monitoring in heart failure patients?
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Which factor is predictive of hospital admission and death in heart failure?
Which factor is predictive of hospital admission and death in heart failure?
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Which of the following therapies can decrease mortality in heart failure?
Which of the following therapies can decrease mortality in heart failure?
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What technique is employed to diagnose ischaemic heart failure and assess suitability for revascularization?
What technique is employed to diagnose ischaemic heart failure and assess suitability for revascularization?
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Which of the following statements is true regarding the diagnosis of heart failure?
Which of the following statements is true regarding the diagnosis of heart failure?
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Study Notes
Heart Failure
- The heart is unable to pump enough blood to meet the body's metabolic needs
- Caused by both functional and structural issues
- Occurs as a clinical syndrome with symptoms like dyspnoea (shortness of breath), fatigue, and volume overload
- Caused by the body's response to cardiac dysfunction
Causes of Heart Failure
- Ischaemic heart disease (CAD) is the most common cause, especially in Western countries
- Dilated cardiomyopathy is the second most common cause
- Hypertension is the most common cause in Zambia
General causes of Congestive Cardiac Failure (CCF)
- Cardiomyopathy: dilated, hypertrophic, restrictive (amyloidosis, sarcoidosis)
- Valvular heart disease: mitral, aortic, tricuspid, rheumatic, endocarditis
- Congenital heart disease: ASD, VSD, TOF
- Alcohol and drugs: chemotherapy - trastuzumab, imatinib
- Hyperdynamic circulation: anaemia, thyrotoxicosis, haemochromatosis, Paget's disease
- Right heart failure: right ventricular infarct, pulmonary hypertension, pulmonary embolism, COPD
- Arrhythmias: atrial fibrillation, bradycardia (complete heart block, sick sinus syndrome - sinus node dysfunction)
- Pericardial disease: constrictive pericarditis, pericardial effusion, tamponade
- Infections: myocarditis (mainly by viruses), infectious endocarditis (mainly by bacteria)
Pathophysiology of Heart Failure
- When the heart fails, the heart and peripheral vascular system adapt to the haemodynamic changes
- These changes are initially compensatory to maintain cardiac output and perfusion
- However, as heart failure worsens, these mechanisms become overwhelmed and pathological
- Factors involved in these changes include venous return, outflow resistance, myocardial contractility, and salt and water retention
Classification of Heart Failure
- Acute heart failure (AHF): Presents suddenly
- Chronic heart failure: Presents gradually
- Systolic dysfunction: Reduced ejection fraction (HFREF), commonly caused by ischaemic heart disease
- Diastolic dysfunction: Preserved ejection fraction (HFPEF), caused by increased ventricular stiffness and decreased compliance
- Right ventricular systolic dysfunction (RVSD): May be secondary to left ventricular dysfunction or primary pulmonary hypertension
New York Heart Association (NYHA) Functional Classification of Heart Failure
- Class I: Ordinary physical activity does not cause symptoms
- Class II: Comfortable at rest, ordinary physical activity leads to symptoms
- Class III: Marked limitation of activity, less than ordinary physical activity leads to symptoms
- Class IV: Inability to perform any physical activity without discomfort, symptoms present at rest
Investigations in Heart Failure
- Blood tests: full blood count, urea and electrolytes, liver biochemistry, cardiac enzymes, BNP or NT-proBNP, thyroid function tests
- Chest X-ray: cardiomegaly, pulmonary congestion, fluid in fissures, Kerley B lines, pulmonary oedema
- Electrocardiogram: Identify ischaemia, hypertension, or arrhythmia
- Echocardiography: Cardiac chamber dimensions, systolic and diastolic function, wall motion abnormalities, valvular disease, cardiomyopathies
- Stress echocardiography: Assess viability in dysfunctional myocardium
- Nuclear cardiology: Quantify ventricular ejection fraction, demonstrate myocardial ischaemia and viability
- Cardiac MRI (CMR): Assess cardiac structure and function, viability using dobutamine or gadolinium
- Cardiac catheterization: Diagnosis of ischaemic heart failure, measurement of pressures
- Cardiac biopsy: Diagnosis of cardiomyopathies, follow-up of transplant patients
- Cardiopulmonary exercise testing: Peak oxygen consumption predicts hospital admission and death in heart failure
- Ambulatory 24-hour ECG monitoring (Holter): Used for suspected arrhythmia and in severe heart failure to determine defibrillator suitability
Treatment of Heart Failure
- Disease-modifying therapy: ACE inhibitors, beta blockers, aldosterone antagonists
- Symptomatic therapy: Diuretics, digoxin, vasodilators
- Other pharmacological therapy: Antiarrhythmic agents, anticoagulants
- Non-pharmacological therapy and lifestyle modification: Diet, exercise, weight control, smoking cessation
- Device therapy: Implantable cardioverter-defibrillator (ICD), cardiac resynchronization therapy (CRT)
- Surgical options: Heart transplantation, valve surgery
Disease-Modifying Therapy
- ACE inhibitors: Improve symptoms and decrease mortality in left ventricular systolic dysfunction, consider in all patients
- Beta blockers: Decrease mortality in patients with heart failure due to left ventricular dysfunction
- Aldosterone antagonists (Spironolactone): Reduce mortality by 30% when added to conventional therapy
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Description
This quiz covers essential information about heart failure, including its definition, symptoms, and various causes. It explores both structural and functional issues leading to this clinical syndrome, highlighting the most common causes such as ischaemic heart disease and hypertension. Test your knowledge on the different types of cardiomyopathy and other contributing factors to congestive cardiac failure.
