13. Heart Failure I: Pathophys

Question 1

What can cause volume overloaded heart muscle?

Answer 1

mitral regurg high cardiac output holes in heart beriberi

Question 2

What can cause cardiac muscle cell destruction?

Answer 2

MI viral myocarditis peripartum cardiomyopathy idiopathic cardiomyopathy alcohol

Question 3

What does HFpEF stand for?

Answer 3

HF with preserved ejection fraction

Question 4

What does PSF stand for?

Answer 4

preserved systolic function

Question 5

What affects the stroke volume?

Answer 5

contractility, preload, afterload

Question 5

What is systolic HF?

Answer 5

a problem with the squeeze; ↓contraction / ↓ inotropy decreased ejection fraction and ventricular enlargement can be heart failure with reduced ejection fraction (HFrEF), left ventricular systolic dysfunction (LVSD), or dilated cardiomyopathy (DCM)

Question 5

What can cause overstressed heart muscle?

Answer 5

tachycardia-mediated HF meth abuse catecholamine mediated

Question 6

What can cause myocardial thickening/fibrosis?

Answer 6

hypertrophic cardiomyopathy 1a restrictive cardiomyopathy

Question 7

What are the 1a causes of R heart failure?

Answer 7

1. L sided heart failure 2. lung disease/pulmonary HTN 3. RV volume overload 4. damage to the RV myocardium

Question 8

For patients with symptomatic HF, half will be dead within _____.

Answer 8

5 years

Question 8

What are the hallmarks of diastolic HF?

Answer 8

1. normal ejection fraction (“HF with preserved ejection fraction” = HFpEF; “preserved systolic function” = PSF) 2. ventricular wall thickening (LVH, HCM)

Question 10

What does DCM stand for?

Answer 10

dilated cardiomyopathy

Question 11

Most heart failure involves?

Answer 11

the L heart

Question 13

What are the 2 main components of HF?

Answer 13

poor forward blood flow (↓ cardiac output) and backward buildup of pressure/congestion (↑ filling pressures)

Question 14

What is cor pulmonale?

Answer 14

when 1a lung disease causes HF

Question 15

What is the outcome of RAAS activation?

Answer 15

o Vascoconstriction o Salt/water retention

Question 17

A hypertrophied heart has ____ HF; a dilated heart has ____ HF.

Answer 17

hypertrophy = diastolic dilated = systolic

Question 18

What determines inotropy?

Answer 18

o Catecholaminergic / adrenergic stimulation o Calcium

Question 19

What can cause high afterload/pressure overload?

Answer 19

hypertension aortic stenosis dialysis (inadequate fluid removal)

Question 19

Name 4 adverse cardiac remodeling outcomes caused by long term increased cardiac workload and metabolic demands.

Answer 19

o Ventricular hypertrophy o Ventricular dilation o Myocardial damage / apoptosis o Myocardial fibrosis

Question 20

Name 2 ways the RV myocardium can get damaged.

Answer 20

1. isolated RV infarct 2. myocarditis

Question 22

Heart failure is ______ to meet the metabolic demands of the body (forward failure), or the ability to do so only if the cardiac filling pressures are abnormally high (backward failure).

Answer 22

the inability of the heart to pump blood forward at a sufficient rate

Question 23

o Vascoconstriction o Salt/water retention These are caused by?

Answer 23

RAAS activation

Question 24

What does LVSD stand for?

Answer 24

left ventricular systolic dysfunction

Question 25

Problems with relaxation cause problems with ____ (↓lusitropy / decrease in relaxation).

Answer 25

filling

Question 26

What can cause external compression?

Answer 26

pericardial fibrosis/constructive pericarditis pericardial effusion

Question 27

Heart failure is the inability of the heart to pump blood forward at a sufficient rate to _____ (forward failure), or the ability to do so only if the cardiac filling pressures are abnormally high (backward failure).

Answer 27

meet the metabolic demands of the body

Question 28

Name 3 general causes of diastolic heart failure.

Answer 28

1. high afterload/pressure overload 2. myocardial thickening/fibrosis 3. external compression

Question 29

What does HCM stand for?

Answer 29

hypertrophic cardiomyopathy

Question 30

What does LVH stand for?

Answer 30

left ventricular hypertrophy

Question 31

Heart failure is the inability of the heart to pump blood forward at a sufficient rate to meet the metabolic demands of the body (forward failure), or the ability to do so only if the cardiac filling pressures are ____ (backward failure).

Answer 31

abnormally high

Question 32

What does HFrEF stand for?

Answer 32

heart failure with reduced ejection fraction

Question 33

HFrER, LVSD, and DCM are all?

Answer 33

systolic HF

Question 34

The median age for CF pts is ___.

Answer 34

75yo

Question 35

o Vasocontriction o Tachycardia o Inotropic augmentation All are caused by?

Answer 35

adrenergic activation

Question 36

What is the outcome of adrenergic activation?

Answer 36

o Vasocontriction o Tachycardia o Inotropic augmentation

Question 37

What causes systolic HF?

Answer 37

o destruction of heart muscle cells (MI, viral myocarditis, peripartum cardiomyopathy, idiopathic cardiomyopathy, alcohol) o overstressed heart muscle (tachycardia-mediated HF, meth abuse, catecholamine mediated) o volume overloaded heart muscle (mitral regurg, high cardiac output, holes in heart, beriberi)