Heart Failure

Heart failure (HF) is a clinical syndrome where the heart cannot pump sufficient blood to meet metabolic demands, classified by ejection fraction (HFrEF vs HFpEF). Chronic management focuses on symptomatic relief and mortality reduction via neurohormonal blockade.

🎯 Key Learning Objectives

1. Differentiate between Right, Left, and Congestive heart failure.
2. Interpret NT-proBNP levels to guide referral and diagnosis.
3. Classify severity using the New York Heart Association (NYHA) system.
4. Manage acute pulmonary oedema with loop diuretics and oxygen.
5. Outline the prognostic medications for HFrEF (ACEi, Beta-blocker, MRA, SGLT2i).
6. Monitor renal function and electrolytes during titration of HF drugs.

🔬 Pathophysiology

Chronic insult (ischaemia, hypertension) leads to ventricular remodeling. Neurohormonal activation of the Renin-Angiotensin-Aldosterone System (RAAS) and Sympathetic Nervous System (SNS) causes fluid retention and further cardiac stress.

🩺 Clinical Features

🔬 Investigations

💊 Management

⚠️ Complications

⭐ High-Yield Pearls

• NT-proBNP > 2000 needs urgent referral for echo within 2 weeks.
• Beta-blockers should only be started once the patient is clinically stable.
• Spironolactone can cause hyperkalaemia and gynaecomastia.
• ACE-inhibitors commonly cause a dry cough; switch to ARBs if required.
• SGLT2 inhibitors are now recommended for all HFrEF patients regardless of diabetes status.

❓ Practice Questions