1. Heart Failure (Acute and Chronic)

📄Definition

Heart failure is a clinical syndrome where the heart is unable to pump sufficient blood to meet the body’s demands.

Types:

  • HFrEF – Reduced EF (≤40%)

  • HFpEF – Preserved EF (≥50%)

  • HFmrEF – Mid-range EF (41–49%)

  • Acute HF – Sudden decompensation

  • Chronic HF – Persistent condition

🧠HARD FAIL

  • HFrEF / HFpEF

  • Acute vs Chronic

  • Remodelling

  • Dyspnoea, fatigue

  • Fluid overload

  • Anxiety

  • Impaired exercise

  • Low perfusion

Pathophysiology

  • ↓ Cardiac output → ↑ RAAS & SNS → fluid retention, vasoconstriction, remodelling

  • HFrEF = systolic failure

  • HFpEF = diastolic dysfunction

🛡️ Risk Factors

🧠 Mnemonic: DAMN HEART

  • Diabetes

  • Age

  • Myocardial infarction

  • NSAIDs/nephrotoxins

  • Hypertension

  • Ethanol

  • Arrhythmias

  • Renal dysfunction

  • Thyroid disease

📋Clinical Features 

🧠 Mnemonic: SOB-FACE

  • SOB (orthopnoea, PND)

  • Oedema

  • Breathlessness on lying

  • Fatigue

  • Ankle swelling

  • Cough (nocturnal)

  • Elevated JVP

📊 Diagnosis

🧠 Mnemonic: BE CALMED

  • BNP or NT-proBNP

  • Echo (EF + structure)

  • CXR (pulmonary oedema)

  • Anaemia check (FBC)

  • LFTs/U&Es

  • MI (Troponin)

  • ECG

  • Diabetes (glucose/HbA1c)

Other tests: TSH, lipids

CXR FINDINGS

🧠 Mnemonic: ABCDE

  • Alveolar oedema (bat-wing)

  • Basal effusions

  • Cardiomegaly

  • Dilated upper lobe veins

  • Effusions (interlobar)

Severity – NYHA Classification

ClassDescription
INo limitation
IIMild limitation
IIIMarked limitation
IVSymptoms at rest

Chronic Management 

🧠 Mnemonic: ABCD TENS

  • ACEi/ARB/ARNI (e.g. sacubitril-valsartan)

  • Beta-blockers (e.g. bisoprolol)

  • Controlled diuretics

  • Dapagliflozin (SGLT2i)

  • Thromboprophylaxis if AF

  • Education (diet/weight)

  • Non-pharm (rehab, vaccines)

  • Spironolactone (MRA)

Acute Decompensated HF Management

🧠 Mnemonic: PUMP FAILURE

  • Position upright

  • Unload with diuretics

  • Morphine (rare)

  • Pressors if hypotensive

  • Furosemide IV

  • ACEi withheld if AKI

  • Investigate cause

  • Low-flow O2

  • Ultrasound lungs

  • Refer to HF team

  • Echo urgent

🩺 Monitoring

  • Weight (target: <2kg/week loss)

  • Monitor U&Es on ACEi/MRA

  • Echo every 1–2 years

  • Digoxin monitoring if used

  • Annual flu + 1-off pneumococcal vaccine

❗Complications

🧠 Mnemonic: CHAD

  • Cardiogenic shock

  • Hypokalaemia / hyponatraemia

  • Arrhythmias

  • Death (sudden cardiac)

Differentials

🧠 Mnemonic: LUNG CHAMP

  • Lung disease (e.g. COPD)

  • Uraemia

  • Nephrotic syndrome

  • GORD

  • Constrictive pericarditis

  • Heart valve disease

  • Anaemia

  • MI

  • PE

Last updated in line with NICE NG106 (Chronic heart failure in adults)
Published: September 2018 • Last updated: March 2023
Last reviewed: July 2025
PASSMAP ensures all content is NICE-aligned and reviewed for Physician Associate Registration Assessment (PARA) success.

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