279 Heart Failure: Pathophysiology and Diagnosis

Question 1

It is a complex clinical syndrome that results from structural or functional impairment of ventricular filling or ejection of blood, which in turn leads to the cardinal clinical symptoms of dyspnea and fatigue, edema and rales

Answer 1

Heart Failure

Question 2

Etiologies of Heart Failure with Depressed EF (<40%)

Answer 2

Coronary artery disease
Myocardial infarction
Myocardial ischemia

Chronic pressure overload
Hypertension
Obstructive valvular diseasea

Chronic volume overload 
  Regurgitant valvular disease
  Intracardiac (left-to-right)       shunting
  Extracardiac shunting
Chronic lung disease
  Cor pulmonale
  Pulmonary vascular disorders 

Nonischemic dilated cardiomyopathy
Familial/genetic disorders
Infiltrative disorders

Toxic/drug-induced damage
Metabolic disordera
Viral

Chagas’ Disease

Disorders of rate and rhythm
Chronic bradyarrhythmias
Chronic tachyarrhythmias

Question 3

Etiologies of Heart Failure with Preserved EF (>40%)-50%

Answer 3

Pathologic hypertrophy
Primary hypertrophic cardiomyopathies
Secondary hypertension
Aging

Restrictive cardiomyopathy
  Infiltrative disorders (amyloidosis, sarcoidosis)
  Storage diseases (hemochromatosis)

Fibrosis

Endomyocardial disorders

Question 4

Etiologies of Heart Failure High Output States

Answer 4

Metabolic Disorders
Thyrotoxicosis

Nutritional disorders (beriberi)

Excessive blood flow requirements
Systemic arteriovenous shunting
Chronic anemia

Question 5

Myocyte Changes during LV Remodeling

Answer 5

Myocyte loss
Necrosis
Apoptosis
Autophagy

Alterations in extracellular matrix
Matrix degradation
Myocardial fibrosis

Question 6

Alterations in Myocyte Biology during LV Remodeling

Answer 6

Excitation-contraction coupling

Myosin heavy chain (fetal) gene expression

β-Adrenergic desensitization

Hypertrophy

Myocytolysis

Cytoskeletal proteins

Question 7

Alterations in LV Chamber Geometry during LV Remodeling

Answer 7

Left ventricular (LV) dilation

Increased LV sphericity

LV wall thinning

Mitral valve incompetence

Question 8

It refers to the changes in LV mass, volume, and shape and the composition of the heart that occur after cardiac injury and/or abnormal hemodynamic loading conditions

Answer 8

Ventricular Remodeling

Question 9

Cardinal Symptoms of HF

Answer 9

Fatigue

Shortness of breath

Question 10

It is defined as dyspnea occurring in the recumbent position, is usually a later manifestation of HF than is exertional dyspnea

Answer 10

Orthopnea

Question 11

It results from redistribution of fluid from the splanchnic circulation and lower extremities into the central circulation during recumbency, with a resultant increase in pulmonary capillary pressure

Answer 11

Orthopnea

Question 12

It refers to acute episodes of severe shortness of breath and coughing that generally occur at night and awaken the patient from sleep, usually 1–3 h after the patient retires

Answer 12

PND

Question 13

Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea, or anginal pain.

Answer 13

NYHA Class III

Question 14

Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.

Answer 14

NYHA Class IV

Question 15

Patients with cardiac disease but without resulting limitation of physical activity. Ordinary physical activ- ity does not cause undue fatigue, palpitations, dys- pnea, or anginal pain.

Answer 15

NYHA Class I

Question 16

Patients with cardiac disease resulting in slight limita- tion of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpita- tion, dyspnea, or anginal pain.

Answer 16

NYHA Class II

Question 17

It is also referred to as periodic respiration or cyclic respiration.

It is caused by an increased sensitivity of the respiratory center to arterial PCO2

Answer 17

Cheyne-Stokes Respiration

Question 18

Pulmonary examination in HF

Answer 18

Pulmonary crackles

Pleural effusion

Question 19

Cardiac examination in HF

Answer 19

Cardiomegaly- displaced PMI

S3- volume overload who have tachycardia and tachypnea

S4- diastolic dysfunction

MR and TR

Question 20

Abdominal examination in HF

Answer 20

Hepatomegaly
Ascites
Jaundice

Question 21

Diagnostic work-up in HF

Answer 21

CBC, Electrolytes, BUN, Serum Creatinine, FBS, OGTT, Lipid Profile, TSH, 12-lead ECG, chest x-ray, 2d echo with DS, MRI, Biomarkers (BNP and NT-proBNP), Exercise testing

Question 22

It provides a comprehensive analysis of cardiac anatomy and function and is now the gold standard for assessing LV mass and volumes

Answer 22

MRI

Question 23

It is the most useful index of LV function

Answer 23

EF

Question 24

It is often referred to as pulmonary heart disease

Answer 24

Cor pulmonale

Question 25

It can be defined as altered RV structure and/or function in the context of chronic lung disease and is triggered by the onset of pulmonary hypertension

Answer 25

Cor pulmonale

Question 26

It is the common pathophysiologic mechanism of cor pulmonale

Answer 26

Pulmonary hypertension

Question 27

Etiology of Chronic Cor Pulmonale

Answer 27

Diseases of the Lung Parenchyma

Disorders of Chronic (Alveolar) Hypoxia

Diseases of the Pulmonary Vasculature

Question 28

It is the most common symptom of cor pulmonale

Answer 28

Dyspnea

Question 29

It is the increase in intensity of the holosystolic murmur of tricuspid regurgitation with inspiration

Answer 29

Carvallo’s sign

Question 30

It is the most common cause of right HF

Answer 30

Left HF

Question 31

ECG in severe pulmonary hypertension

Answer 31

P pulmonale
Right axis deviation
RV hypertrophy

Question 32

Chest x-ray findings in cor pulmonale

Answer 32

Enlargement of the main central pulmonary arteries and hilar vessels