Heart Failure
Cardiology (12%) Core Clinical Conditions
1B: Able to identify the condition as a possible diagnosis: may not have the knowledge or resources to confirm the diagnosis or to manage the condition safely, but can take measures to avoid immediate deterioration and refer appropriately
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Definition Aetiology Pathophysiology Risk factor Sign and Symptoms Investigations Management
Definition
Heart failure is a complex clinical syndrome that occurs when the heart cannot adequately pump blood to meet the needs of the body. This can be caused by structural or functional heart muscle abnormalities.
Aetiology
Coronary artery disease: occurs when the arteries that supply blood to the heart become obstructed or constricted.
Hypertension: the heart has to work harder, leading to hypertrophy of the heart muscle. This can lead to heart failure over time.
Diabetes: can increase the risk of heart failure by causing damage to the blood vessels and nerves that regulate the heart.
Cardiomyopathy.
Congenital heart disease.
Others: obesity, sleep apnea, and certain medications.
Pathophysiology
Initially in heart failure, the heart is able to increase its heart rate and cardiac output to compensate for its diminished ability to pump blood. The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system accomplishes this (RAAS). However, as time passes, the effectiveness of these compensatory mechanisms diminishes, resulting in a decline in cardiac output and tissue perfusion.
In an effort to maintain blood pressure and tissue perfusion, the heart releases hormones such as adrenaline, noradrenaline, and angiotensin II. This result in vasoconstriction, sodium retention, and water retention.
Finally, there is a continued hypertrophy, fibrosis and dilation of the heart muscles. This eventually will result in chronic heart failure.
Risk factors
Older age above 65.
Male Sex.
Family history.
Coronary artery disease.
Hypertension .
Diabetes.
Smoking.
Obesity.
Alcohol.
Sign and symptoms
Fatigue/ Tiredness.
Shortness of breath at rest or on exertion.
Pink frothy sputum.
Swollen ankle/leg.
Orthopnea.
Tachycardia or irregular heartbeat.
Reduced exercise tolerance.
Chest pain.
O/E - Crackles can be heard and/or murmurs.
Investigations
Bloods: Brain natriuretic peptide (BNP), kidney function and liver function test,
Echocardiography,
Electrocardiogram (ECG),
Chest X-ray: check the heart size and any build up of fluid.
Cardiac MRI.
Cardiac catheterization.
Management
Lifestyle changes: healthy diet, regular exercise, smoking cessation and weight management.
Medications: diuretics to reduce fluid buildup in the body (such as Furosemide); ACE inhibitors or ARBs (such as Ramipril or Losartan); Beta-blockers (such as bisoprolol) can help to reduce the workload on the heart and improve heart function; Aldosterone antagonists (such as Spironolactone) to reduce fluid buildup in the body and improve heart function; Digoxin: to improve heart function and reduce symptoms of heart failure.
Surgery: Coronary artery bypass grafting (CABG); Implantable cardioverter defibrillator (ICD): a device that can be placed in the chest to track the heart's rhythm and, if necessary, deliver an electric shock to restore a normal rhythm.
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