Heart Failure

Jake Melhuish takes you through the definitions, signs, classification and important treatment principles of heart failure.

 

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Video Duration: 16 minutes

  • Heart Failure
    Created by Jake Melhuish
    General
    Epidemiology

    Heart failure is defined as a clinical syndrome characterised by symptoms, signs and evidence of structural or functional abnormality.

    Men>Women, common, 8 per 1,000 in the population

    Pathology

    Original insult causing myocardial injury -> fall in left ventricular performance -> remodelling

    Top three causes
    1. Idiopathic
    2. Ischaemic
    3. Hypertension
    Clinical Features
    Symptoms

    Fatigue, ankle swelling and breathlessness

    Signs

    Tachycardia, tachypnoea, pulmonary congestion, pleural effusion, raised jugular venous pressure, peripheral oedema and hepatomegaly

    Investigations
    Cultures

    None

    Bloods

    To assess aetiology:

    FBC, U&E, creatinine, LFTs, glucose, fasting lipids, TFTs, cardiac enzymes

    Imaging
    • CXR - findings include cardiomegaly, ventricular hypertrophy, prominent upper lobe veins, peribronchial cuffing, fluid in the fissures, pleural effusions, kerly B lines and diffuse interstitial shadowing (bats wings)
    • Echocardiogram - can show reduced ejection fraction and structural abnormalities
    • Cardiac magnetic resonance - to assess ventricular volumes, mass and wall motion
    Scopic/Biopsy

    Endomyocardial biopsy is rarely needed

    Functional

    6 minute walk test

    Treatment
    Conservative

    Patient education - dietary and exercise advice, psychosocial aspects, recognition of symptoms and risk factor modification (smoking cessation, alcohol)

    Medical
    • ACE inhibitors/ARBs - all patients with ejection fraction <40%, check U&Es
    • Diuretics - e.g. furosemide, these are given for symptoms relieve and do not change prognosis.
    • Beta-blockers - e.g. bisoprolol, used in all patients with an ejection fraction <40%
    • Statins - to reduce risk of further coronary artery disease
    • Anti-coagulant/anti-platelets - heart failure patients have an increased incidence of strokes and emboli
    Surgical
    • Percutaneous coronary intervention - for existing coronary vascular disease
    • Valvular disease - useful if patient has existing valve disease
    • Heart transplantation - in very select patients
    • Left ventricular assist devices - in very select patients