11 18 2014 Heart Failure

Question 1

Epidemiology

Answer 1

500,000 new cases a year Prevalence = 5 million # of heart failure is increasing due to aging population AND interventions that prolong life after serious and damaging cardiac insults. Age 65 or older

Question 2

what are the 3 determinants of stroke volume?

Answer 2

preload Afterload Myocardial contractility

Question 3

Risk factors for Heart Failure?

Answer 3

Hypertension

Atherosclerotic heart disease ( CAD #1 for systolic heart failure)

Diabetes

Obesity

Metabolic syndrome

Cardiotoxins (alcohol/ medication/chemotherapy)

Family hisotry of cardiomyopathy

Question 4

Stages of Heart failure?

Answer 4

Stage A

High risk factors with no symptoms of heart failure

Stage B

Structural heart damage/disease, no symptoms

Stage C

Structural disease, previous or current symptoms

Stage D

Refractory symptoms requring special interventions

Question 5

Functional stages of heart failure?

Answer 5

Class I: no functional impairment

Class II: dyspnea at moderate exertion

Class III: Dyspnea at minimal– mild exertion

• can’t go up stairs or can’t roll garbage can to corner

Class IV: Dyspnea at rest ( rare)

Question 6

Natural history of heart failure?

Answer 6

sadf

Question 7

Ejection fraction formula?

Answer 7

= SV/ EDV

Question 8

systolic heart failure

Answer 8

Systolic heart failure is the inability of the heart to pump out enough blood to meet demand. Decrease in CO.

• decrease of ESPVR slope in Pressure-volume loop – systolic emptying ceases at a higher than normal end-systolic volume.
• Damage to myoctyes – fibrosis = dysfunction

= decrease in stroke volume.

* heart failure with decreased EF

Question 9

Diastolic heart Failure

Answer 9

Diastolic heart failure is the inability of the ventricle to hold a lot of blood – aka not compliant enough to get the blood the body needs. Decrease in C)

* Heart failure with preservation of EF (ejection fraction)

Question 10

Isolated right heart failure causes?

Answer 10

• (less common)
• diseases of the lung parenchyma or pulmonary vasculature

*corpulmonale

Question 11

Compensatory mechanisms for heart failure?

Answer 11

1. Frank-Starling mechanism

• increase stretching of myocytes (due to incomplete emptying of chamber)
• induce greater stroek volume on subsequent contractions
• had a limit

2. Neruohormonal alterations

• Adrenergic nervous system– baroreceptor reflex
• RAAS
• ADH produciton and release from posterior pituitary

* increase systemic vascular resistance

3. development of ventricular hypertrophy and remodeling

Question 12

Symptoms of left sided heart failure:

Answer 12

• Dyspnea (most prominent feature)
• Orthopnea
• Paroxysmal nocturnal dyspnea: severe breathlessness that awakens the patient from 2 to 3 hrs after retiring to bed
• nocturnal cough
• Fatiue (exercise intolerance)

Question 13

Physical findings of someone with left sided heart failure

Answer 13

• Diaphoresis (sweating)
• Tachycardia, tachypnea (hyperventilation)

(due to decrease fluid loss and decrease perfusion of kidneys)

• Pulmonary rales
• Loud P2
• S3 gallop ( in systolic heart failure)
• S4 gallop (diastolic heart failure)
• Mitral Regurgitation ( LV dilation)

Question 14

Symptoms of right heart failure

Answer 14

• peripheral edema
• right upper quadrant discomfort ( due to hepatic enlargement)

Question 15

Physical findings of right sided heart failure

Answer 15

• Jugular Venous Distention
• Hepatomegaly
• Peripheral Edema
• tricuspid regurgitation (due to RVH)