Cardiovascular15 UKMLA questions
Heart Failure — UKMLA Revision Notes
Heart failure is a clinical syndrome in which the heart cannot pump sufficient blood to meet the body's metabolic demands, or can only do so at elevated filling pressures. Classified by ejection fraction: HFrEF (EF <40%), HFmrEF (40–49%), and HFpEF (≥50%).
Key Facts
- Most common cause: ischaemic heart disease and hypertension
- BNP/NT-proBNP: key diagnostic biomarker; guides diuretic therapy
- Echocardiogram: essential to classify HF and identify aetiology
- ACE inhibitor + beta-blocker + MRA: cornerstone of HFrEF treatment
- SGLT-2 inhibitors (dapagliflozin, empagliflozin) reduce hospitalisation in HFrEF
Investigations
- BNP or NT-proBNP: raised in HF; guides urgency of echocardiogram
- Echocardiogram: LV function, EF, valvular disease
- CXR: cardiomegaly, pulmonary oedema (bat-wing shadowing, Kerley B lines)
- ECG: identify underlying cause (MI, AF, LBBB)
- U&E, eGFR: before and during diuretic/ACEi therapy
Management
- ACE inhibitor (ramipril) or ARB: first-line for HFrEF
- Beta-blocker (bisoprolol, carvedilol): start low, titrate up
- MRA (spironolactone/eplerenone): if EF <35% despite ACEi + BB
- SGLT-2 inhibitor (dapagliflozin): add for HFrEF regardless of diabetes
- Loop diuretic (furosemide): symptom relief for fluid overload
NICE Guideline: NICE NG106 — Chronic heart failure in adults: diagnosis and management (2018)
Related UKMLA Conditions
Atrial FibrillationMyocardial InfarctionHypertensionCKD