Heart Failure in MRCP Part 1

Introduction
It means failure of pumping action of the heart. Heart failure may be Diastolic (less filling) or Systolic (less output) or both. Echocardiogram findings of Ejection Fraction (EF) indicates mostly systolic function of the heart. Normal EF does not exclude diastolic dysfunction. Symptoms (Breathlessness, Fatigability, Palpitation) of heart failure are very important.

Clinical Presentation
May be of Left or Right heart failure or both. Peripheral edema is the common presentation of right heart failure. Breathlessness is the common presentation of left heart failure.

Diagnosis
Symptoms are the main indicator of diagnosis. But subclinical heart failure can be diagnosed by investigation eg BNP (B type Natriuretic peptide) level.

Stage/ Grade of Heart Failure
Staging is very important to design treatment plan. Heart failure is categorized as Stage A, B, C, D. Treatment is mainly designed according to this staging. NYHA functional classification of heart failure well accepted one and this classification has great impact on further therapeutic decision making.

Investigation of Heart Failure
1) To diagnose heart failure: (BNP level)
2) To identify causes of heart failure eg IHD
3) To identify complications eg renal function
4) To identify prognostic factor/ aggravation factor or co morbidities

Management
Depends on stage (A, B, C, D) of heart failure. Some drugs are chosen according to NYHA functional classification. 4 groups of drug are important for mortality outcome and these drugs are introduced step by step. There are multiple drugs which act at different pathophysiologic (neurohumoral) mechanism of heart failure. General management is very important. Some patient may need CRT.

For further details see NICE guideline of Heart Failure.

DOAMSmrcp suggestion of heart failure

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