Clinical Quiz: Chronic Heart Failure

Discover how much you know about this disease in our true-or-false quiz
1. Hypertension is the most important cause of chronic heart failure worldwide. True/False
2. A raised jugular venous pressure or presence of a third heart sound will always be seen in heart failure. True/False
3. The most obvious symptom of chronic heart failure is dyspnoea. True/False
4. About one in five patients with left ventricular systolic dysfunction (LVSD) will have an abnormal resting ECG. True/False
5. Brain natriuretic peptide is not a sensitive marker for heart failure, but has high specificity. True/False
6. Radionucleotide ventriculography is more precise than echocardiography. True/False
7. MRI and/or computerised tomography will be key techniques in future heart failure assessment. True/False
8. ACE-inhibitors should be used before beta-blockers in patients with reduced LV systolic function. True/False
9. Eplerenone can be used in spironolactone-intolerant patients. True/False
10. In dyspnoea and fluid retention, frusemide is preferable to bumetanide, as it offers improved gut retention and less gout. True/False
11. LV systolic dysfunction is linked with increased mortality, which can almost always be attributed to eventual pump failure. True/False
12. Cardiac resynchronisation therapy will eventually reduce LV end diastolic volume, which will result in reduced LV dimensions and improved LV ejection and prognosis. True/False
13. One-year mortality in cardiac transplants is around 5%. True/False

Answers 1. True - At least 50% of UK patients have it. Ischaemic heart disease (IHD) with previous myocardial infarction is the most common cause in the developed world.
2. False - These strongly suggest heart failure, but their absence does not rule it out.
3. True - Patients also complain of fatigue, peripheral fluid retention, reduced appetite and weight loss. Symptoms such as chest pain in IHD or palpitations in tachycardia may be present.
4. False - This is seen in most patients with LVSD, along with abnormalities such as Q waves suggesting previous infarction, left bundle branch block, atrial fibrillation and LV hypertrophy.
5. False - It is actually very sensitive, but as it is also raised in conditions such as COPD, it loses specificity.
6. True - It is more reproducible than echocardiography. However, patients are exposed to ionising radiation with the injection of a nuclear tracer.
7. True - MRI is excellent in assessing cardiomyopathies and IHD. Availability is the main limitation in use of these techniques.
8. False - Historically this was the practice, but recent evidence provides no support for either as the starting management. Patients with reduced LV systolic function should be on both drugs, barring contraindications.
9. True - It now has a UK licence for symptomatic LV dysfunction post-acute MI. However, use with caution, as hyperkalaemia is a significant side-effect.
10. False - Bumetanide offers this advantage over frusemide. If fluid overload persists, loop diuresis can be complemented with a thiazide.
11. False - Although pump failure is a factor, a large proportion of the increased mortality is due to arrhythmic sudden death.
12. True - CRT paces both the septum and lateral LV wall via the coronary sinus and stimulates the septum and lateral wall simultaneously, providing maximal cardiac output.
13. False - Early mortality of transplant is about 20%. The number of patients with a predicted annual mortality greater than 20% is falling dramatically.
Reference Cormack A, Brady A. Update 2007; June; 19-28