12. Heart failure

Question 1

Left sided heart failure is due to

Answer 1

hypertension

Question 2

Right sided failure is due to

Answer 2

chronic lung disease

Question 3

Biventricular failure

Answer 3

LV HF = pulmonary congestion = RSHF

Question 4

Clinical features of heart failure

Answer 4

Hypotension

Oedema

tiredness and dizziness

Cold peripheries

Atrial fibrillation

Reduced urine flow

Question 5

Mechanism of Left sided heart failure - systolic dysfunction

Answer 5

impaired contractility + pressure overload → left ventricular systolic dysfunction→ Left sided heart failure

Question 6

Left Sided Heart Failure due to Systolic Dysfunction causes an

Answer 6

↑ESV

↑EDV

downwards, rightwards shift in graph

Question 7

Mechanism of Left sided heart failure - diastolic dysfunction

Answer 7

reduced V wall comp + Obstruction of LV filling → LV diastolic dysfunction → LSHF

Question 8

Cardiac Failure - Diastolic dysfunction

Answer 8

↓ EDV

↓ SV

upwards shift in graph

Question 9

Compensatory mechanisms in heart failure

Answer 9

Question 10

Answer 10

a. Cardiac performance increases as a function of pre-load
b. ↓ V contractility = ↑ EDV = so fall in SV is less
c. ↑ LV filling = pulmonary congestion

Question 11

In Heart Failure a reduced Stroke Volume and hence Cardiac Output activates:

Answer 11

• Sympathetic reflexes
• ADH release
• Renin angiotensin system

Question 12

Drugs used to treat
heart failure

Answer 12

• Diuretics
• Positive inotropes
• Vasodilators
• Beta adrenoceptor antagonists

Question 13

Answer 13

a. ↓ SV, ↑LVEDP = pulmonary congestion
b. Diuretics reduce pc but do not increase SV

b’. Excessive diuresis = ↓SV = hypotension

Inotropic therapy (c) and arteriolar dilation (d) ↑ SV = ↑ V emptying = ↓LVEDP

e. represents the potential of combining vasodilator and inotropic therapy

Question 14

Treatment of Heart Failure - Vasodilators

Answer 14

act on the venous side = ↓pre-load, ↓ risk of p.c

act on the arterial side = ↓after-load, ↑SV

Question 15

Venodilator

Answer 15

nitrates

Question 16

mixed vasodilators

Answer 16

nitroprusside

alpha-adrenergic blockers

ace inhibitors

alpha2-central agonists

Question 17

arteriolar dilators

Answer 17

hydralazine

minoxidil

CCBs

Question 18

Inotropes

Answer 18

Stimulate cardiac b1 receptors

Short 1/2 life

IV infusion via central line

Risk of arrhythmias

May increase myocardial oxygen demand

Question 19

K+ losing diuretics

Answer 19

1) Loop diuretics
2) Thiazide diuretics

Question 20

K+ sparing diuretics

Answer 20

1) Aldosterone antagonists
2) Aldosterone independent

Question 21

Left Sided Heart Failure due to Systolic Dysfunction change in graph

Answer 21

a downward and rightward shift in the relationship (from 1 to 2)

Question 22

Left Sided Heart Failure due to Diastolic dysfunction change in graph

Answer 22

curve is shifted up (1 to 2)

Question 23

Heart failure can be indicated on an echocardiogram by an ejection fraction less than…

Answer 23

45%

Question 24

Furosemide

Answer 24

Loop diuretic

Question 25

Bumetanide

Answer 25

Loop diuretic

Question 26

Bendroflumethiazide

Answer 26

Thiazide diuretics

Question 27

Spironolactone

Answer 27

Aldosterone antagonist

Question 28

Eplerenone

Answer 28

Aldosterone antagonist

Question 29

Amiloride

Answer 29

Aldosterone independent