Phys · cardiovascular
Heart Failure
Also known as cardiac failure · congestive cardiac failure · CCF · congestive heart failure · chronic heart failure · acute heart failure · HFrEF · HFpEF · systolic heart failure · diastolic heart failure
Consultant-physician-depth guide to heart failure diagnosis, classification, investigation, and the four pillars of guideline-directed medical therapy (GDMT) for HFrEF — structured for FRACP DWE and DCE preparation.
On this page
Study tools
Your progress
Saved on this device.
Practise this topic
Target exams
Red flags
- Acute pulmonary oedema requiring NIV or intubation
- Cardiogenic shock (hypotension + hypoperfusion)
- Syncope with structural heart disease (possible arrhythmic death risk)
- New AF with rapid ventricular response and decompensation
- Rising troponin without ACS (type 2 MI from low output)
Heart Failure
Meet the patient
A 72-year-old woman presents with three months of exertional dyspnoea, orthopnoea and ankle swelling. She has a background of ischaemic heart disease, type 2 diabetes, hypertension and stage 3B chronic kidney disease. The echo shows an LVEF of 32 per cent. She is on ramipril and frusemide only. [1]
The first question the long case asks is not what is wrong — the echo answered that — but what is missing from her prescription. She needs the other three pillars on board, iron studies checked, and an anticoagulation decision for her paroxysmal AF. The four-pillar framework turns a complicated patient into a checklist. [1]
References5ShowHide
- [1]McMurray JJV, Packer M, Desai AS, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure N Engl J Med, 2014.PMID 25176015
- [2]McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction N Engl J Med, 2019.PMID 31535829
- [3]Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators N Engl J Med, 1999.PMID 10471456
- [4]MERIT-HF Study Group Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF) Lancet, 1999.PMID 10376614
- [5]Hall AS, Murray GD, Ball SG. Follow-up study of patients randomly allocated ramipril or placebo for heart failure after acute myocardial infarction: AIRE Extension (AIREX) Study. Acute Infarction Ramipril Efficacy Lancet, 1997.PMID 9167457