3.B-Heart Failure Basics

Question 1

True or false: heart failure is a condition that relies heavily on antihypertensives with blood pressure reduction being the goal

Answer 1

false
antihypertensives are heavily relied on but blood pressure reduction is NOT the goal

Question 2

What is the fundamental problem with heart failure?

Answer 2

reduced cardiac output

Question 3

What will happen in the kidney in someone with heart failure?

Answer 3

the reduced CO means less blood pumped to the kidney thus glomerular pressure will decrease which results in:
-renin release
-RAAS activation but RAAS wont improve GFR
-RAAS will be active 24/7

Question 4

If the CO of the left ventricle decreases but the amount of blood returned to the heart is not changed, what happens to the pressure in the vena cava?

Answer 4

increases
it will expand due to the backup of blood flow

Question 5

What is preload?

Answer 5

the degree to which the ventricle(s) is stretched before it contracts
also called filling pressure

Question 6

What is the preload like in someone with heart failure?

Answer 6

preload is high
due to the high volume of blood being returned but not cleared
not able to pump all the blood returning from the venous system
blood backs up and increases preload

Question 7

Why is high preload exacerbated by RAAS activation?

Answer 7

RAAS activation by the kidney is putting more fluid in the system but the left ventricle is doing a poor job of ejecting blood therefore GFR is not fixed and RAAS continues to be activated

Question 8

What is Starlings Law?

Answer 8

the force of contraction is proportional to the initial length of the cardiac muscle fiber
-increased preload (stretch)=increased work of the heart
(MVO2)
-HF lacks this stretch and work

Question 9

What happens to the body (not in terms of symptoms) from heart failure?

Answer 9

high adrenaline and RAAS due to baroreceptors
high preload
reduced blood flow to the brain
reduced blood flow to muscles

Question 10

What are the primary symptoms of heart failure?

Answer 10

dyspnea (difficulty breathing)
fatigue

Question 11

What are the two main types of heart failure?

Answer 11

HFpEF-heart failure with preserved ejection fraction
-diastolic disfunction (relaxation disfunction)
HFrEF-heart failure with reduced ejection fraction
-left ventricular systolic disfunction (contraction disfunction)

Question 12

What is ejection fraction?

Answer 12

the % of blood in the left ventricle that is pumped out during contraction

Question 13

What is normal ejection fraction?

Answer 13

50-75%

Question 14

True or false: in HFpEF the ejection fraction is off but the CO is in normal range

Answer 14

false
ejection fraction is in the normal range but CO is low

Question 15

What are the most common causes of heart failure?

Answer 15

heart attack (70% of HFrEF cases)
hypertension (the slow way to get heart failure)

Question 16

Which drugs are used for HFrEF?

Answer 16

volume overload: TZD or loop diuretics and SGLT-2 inhibitors
RAAS activation: entresto or ACEI/ARB
MRA
SNS activation: beta blockers

Question 17

Why are diuretics used in HFrEF?

Answer 17

reduces the symptoms associated with fluid retention
-volume overload
-high preload
-edema
-pulmonary congestion
-orthopnea

Question 18

Why are ACEI or ARBs or Entresto used in HFrEF?

Answer 18

reduces ANGII and aldosterone
-vasoconstriction
-cardiac remodeling
-SNS activation
-Na and fluid retention

Question 19

Why are MRAs used in HFrEF?

Answer 19

benefits of further aldosterone blockade
-reduce cardiac fibrosis and remodeling
-reduce inflammatory trigger
-reduce progression of arterial narrowing

Question 20

Why are beta blockers used in HFrEF?

Answer 20

beneficial effects of interfering with SNS transmission
-reduced exposure of cardiac cells to NE
-may reverse some remodeling of cardiac tissue
-lower HR–>improves ventricular filling time–>can improve EF

Question 21

True or false: non-DHP CCBs are safe in heart failure

Answer 21

false
they dont shield the heart against adrenaline

Question 22

What is heart failure?

Answer 22

a progressive clinical syndrome that can result from changes in cardiac structure or function that impairs the ability of the ventricle to fill with or eject blood

Question 23

What is the result of RAAS overstimulation due to decreased GFR (induced by heart failure)?

Answer 23

fluid retention
edema
increased vascular volume

Question 24

What would to a normal healthy heart when there is an increased venous return?

Answer 24

in a healthy heart, an increased venous return is accompanied by an increased cardiac workload
-absent in heart failure

Question 25

What are the medications used in HFpEF?

Answer 25

ongoing research to identify the best way to manage

Question 26

What are common challenges associated with heart failure medications?

Answer 26

blood pressure reduction
-drugs used in HFrEF are not for lowering bp
-bp reduction becomes a side effect
renal perfusion
-lower GFR
-K can increase