Heart failure can be classified in terms of:
- the ventricle affected
- right ventricular failure
- left ventricular failure
- diastolic versus systolic heart failure
Clinical Features of heart failure:
- with respect to the different classifications of heart failure
- what are features of right ventricular failure
- what are features of left ventricular failure
- are third and fourth heart sound sensitive markers for left ventricular dysfunction?
- with respect to the third heart sound
- with respect to the fourth heart sound
- be aware of the NYHA classification of heart failure
Epidemiology of heart failure:
Assessment of possible heart failure in primary care:
- what investigations are useful in the assessment of heart failure in primary care
- what is the role of brain natriuretic peptide (BNP) in the diagnosis of chronic heart failure
- what about patients with AF?
- what if a patient has a normal ECG and normal BNP levels?
- GPN reference
- ECG changes that may be seen include:
- left ventricular hypertrophy which may be caused by chronic hypertension or aortic stenosis
- evidence of ischaemic heart disease
- p-mitrale of mitral stenosis
- what is the ECG definition of LVH
Management of heart failure:
- with reference to the management of chronic heart failure
- what medical therapies are effective in terms of reducing morbidity and mortality in chronic heart failure?
- what medical therapies are effective in terms of symptomatic control?
- GPN reference
- with respect to medical treatment for chronic heart failure with left ventricular dysfunction
- ACE inhibitors in heart failure
- which is started first, an ACE inhibitor or a beta blocker ?
- GPN reference
- is there evidence for the use of higher, rather than lower, doses of ACE inhibitors in chronic heart failure?
- what about the use of ACE inhibitors in renal impairment?
- beta blockers in heart failure
- with respect to beta blockers in left ventricular dysfunction
- GPN reference
- which beta blocker, carvedilol or metoprolol?
- which patients with heart failure should not be prescribed beta blockers?
- aldosterone in heart failure
- with respect to aldosterone antagonists
- what is the concern with using this medication in combination with ACE inhibitors?
- what is a suggested maximum dose of spironolactone in this treatment group?
- what is eplerenone and what is the signficance of the EPHESUS
- digoxin in heart failure
- with respect to digoxin in heart failure
Additional reading:
Summary of NICE heart failure guidance