2.3 Heart Failure

Question 1

What is heart failure?

Answer 1

• impaired ability of ventricles to fill & pump blood effectively
• heart unable to meet metabolic demands of body
• end result of many conditions

Question 2

Pulmonary edema?

Answer 2

abnormal accumulation of fluid in interstitial tissue & alveoli of lungs.
-may be caused by cardiac & NON cardiac disorders.

Question 3

Neurohormone effects on the Cardio system

Aldosterone:

Answer 3

• causes Na and H2O retention
• induces vasoconstriction
• increases preload and afterload

Question 4

Neurohormone effects on the Cardio system

Angiotensin II:

Answer 4

• increases preload and afterload
• increases hypertrophy of ventricular cells with prolonged secretion
• constricts the renal vasculature
• stimulates release of aldosterone, endothelin-1, and vasopressin. (potent vasoconstrictor)

Question 5

Neurohormone effects on the Cardio system

BNP:

Answer 5

• causes vasodilation

- promotes diuresis and natriuresis (but not enough to counteract the effects of the other hormones)

Question 6

Neurohormone effects on the Cardio system

Endothelin-1:

Answer 6

-increases in angiotensin II and norepinephrine release

Question 7

Neurohormone effects on the Cardio system

Epinephrine:

Answer 7

-causes vasoconstriction and increases afterload

Question 8

Neurohormone effects on the Cardio system

Norepinephrine:

Answer 8

increases cardiac contractility

Question 9

Neurohormone effects on the Cardio system

Renin:

Answer 9

-stimulates angiotensin II production

Question 10

The heart is unable to contract forcefully enough in systole to eject adequate amounts of blood into the circulation; ejection fraction drops from 50-70% to less than 40%

Answer 10

What is Systolic Heart Failure

Question 11

Ventricle is unable to relax adequately during diastole; ejection fraction may be normal

Answer 11

What is Diastolic Heart Failure

…….sounds diabolic….:)

Question 12

Common causes of left-sided heart failure?

Answer 12

• coronary heart disease

- hypertension

Question 13

Common causes of right-sided heart failure?

Answer 13

• conditions that restrict blood flow to the lungs

- COPD

Question 14

The abrupt onset of myocardial injury, sudden decreased cardiac function…

Answer 14

Acute heart failure

Question 15

Progressive deterioration of the heart muscle b/c of cardiomyopathies, valvular disease or coronary heart disease

Answer 15

Chronic heart failure

Question 16

In cardiogenic pulmonary edema what is severely impaired?

Answer 16

The left ventricle

Question 17

What is the leading cause of heart failure?

Answer 17

Coronary heart disease (ischemic heart disease)

Question 18

Manifestations of left-sided failure?

Answer 18

• fatigue & activity intolerance
• syncope
• dyspnea
• SOB
• orthopnea (difficulty breathing when supine)
• cyanosis

Question 19

Manifestations of right-sided failure?

Answer 19

• edema in feet & legs
• edema in sacrum if bedridden
• distended neck veins
• nausea & anorexia

Question 20

Paroxysmal nocturnal dyspnea

Answer 20

waking at night acutely short of breath

Question 21

Beta-Blockers

Answer 21

• inhibit SNS activity
• improve cardiac function
• reduce force of contraction (decreases workload)

Question 22

Diuretics

Answer 22

• relieve symptoms related to fluid retention

- Loop diuretics often used - Lasix (furosemide)

Question 23

Vasodilators

Answer 23

• relax smooth muscle
• reduces peripheral vascular resistance & afterload
• decreases myocardial work
• venous dilation reduces preload

Question 24

Digitalis

Answer 24

Glycosides

• positive inotropic effect
• increase strength of contraction
• decreases SA node automaticity, slows conduction
• increases ventricular filling time.

Question 25

What kind of diet is recommended

Answer 25

low salt diet