Acute and Chronic heart failure I&II - Adje

Question 1

ejection fraction

Answer 1

EF = SV / EDV

Question 2

stroke volume

Answer 2

SV = LVEDV - LVESV

Question 3

increase in sympathetic activity to heart

Answer 3

increase contractility and HR

Question 4

increase in contractility

Answer 4

increase SV and preload back to heart

Question 5

increase preload

Answer 5

increase force of contraction

Question 6

increase afterload

Answer 6

increase contractility

Question 7

increase HR

Answer 7

increase contractility

• Pos chronotropes –> increase HR (ex. NE) –> bind to beta 1
• Neg chronotropes –> decrease HR (ex. Ach) –> bind to M2

Question 8

during exercise***

Answer 8

-strenuous exercise –> muscles take up 85% of CO (effects of local vasodilators)

• SNS –> increases HR, increases SV (due to increase in preload and contractility)
• decrease afterload (decrease PVR and increase perfusion to muscles)

Question 9

HFrEF vs. HFpEF***

Answer 9

1. HFrEF –> systolic heart failure (EF <40%)
   - CAD > chronic pressure/volume overload
2. HFpEF –> diastolic heart failure (EF >40%)
   - pathologic hypertrophy, restrictive cardiomyopathy, aging, fibrosis

heart failure = heart can’t fill, heart can’t pump

Question 10

2 main causes of depressed EF (HFrEF)*****

Answer 10

structural heart disease**

1. older person –> CAD or atherosclerosis
2. younger –> viral myocarditis

Question 11

pathogenesis of HFrEF**

Answer 11

decline in pumping capacity –> compensatory mechanisms activated to prevent end organ damage

1. adrenergic nervous system –> to maintain CO
2. RAAS –> Na+ and H20 retention***
3. cytokine storm

LV remodeling over time

Question 12

cardinal symptoms of heart failure***

Answer 12

• fatigue and SOB (dyspnea)***

- pulmonary congestion due to accumulation of fluid –> activate J receptors –> rapid, shallow breathing

Question 13

orthopnea

Answer 13

• SOB in recumbent (increased pulmonary capillary pressure)
• nocturnal cough
• relieved with sitting up

Question 14

paroxysmal nocturnal dyspnea (PND)***

Answer 14

-acute episodes of severe SOB and coughing at NIGHT and awaken from sleep

• 1-3hr after falling asleep
• increased pressure in bronchial arteries –> airway obstruction –> airway resistance

-differentiate from cardiac asthma* (wheezing secondary to bronchospasm)

Question 15

Cheyen-stokes respiration

Answer 15

• periodic respiration
• due to increase sensitivity of respiratory center to arterial PCO2**
• apneic phase (drop O2, rise in CO2) –> stimulate respiratory center –> hyperventilation and hypocapnia
• differentiate from sleep apnea*

Question 16

New York Heart classification*****

Answer 16

1. class I - NO limitation of physical activity
2. class II - SLIGHT limitation
   - ordinary physical activity brings on symptoms
3. class III - MARKED limitation
   - less than ordinary activity
4. class IV - even at REST
   symptoms: fatigue, palpitation, dyspnea, anginal pain

Question 17

Jugular Veins**

Answer 17

• estimation of RA pressure
• head tilted 45 degrees
• normal JVP = 8cm of water*****
• add 5cm
• measuring height above sternal angle

Question 18

what are specific for heart failure?***

Answer 18

• RALES** on pulmonary exam (fluid in alveoli)

- S3** gallop (protodiastolic gallop) on cardiac exam from volume overload

Question 19

CHF**

Answer 19

• rales
• JVP >10
• S3
• peripheral edema (hepatomegaly, ascites, jaundice)

Question 20

what lab test is most helpful i heart failure?***

Answer 20

-BNP or Pro-BNP**

Question 21

what is the only test that will help you differentiate b/w HFrEF and HFpEF?*****

Answer 21

• ECHO** (assesses LV function)
• EF is normal (>/=50%)
• EF depressed (<30-40%)
• chest Xray used to diagnose cardiomegaly

Question 22

what biomarker is diagnostic for heart failure?***

Answer 22

• Brain Natriuretic peptide (BNP)**
• released from heart ventricles
• high BNP –> fluid retention

-Dyspnea –> high BNP or NT-proBNP = diagnosis of HF***

Question 23

acute pulmonary edema symptoms*****

Answer 23

• dyspnea at rest
• tachypnea
• tachycardia
• severe hypoxemia
• crackles and wheezing from alveolar flooding and bronchial compression
• release catecholamines –> HTN

Question 24

cor pulmonale

Answer 24

• altered RV structure and function (right side heart failure) in chronic lung disease from pulmonary HTN (or any lung disease)
• dyspnea most common symptom
• COPD and chronic bronchitis responsible for 50% of cases

physical exam

• Auscultation –> LOUD P2***** in pulmonary HTN
• TR murmur
• high JVP
• hepatomegaly
• ascites
• lower extremity edema
• cyanosis

Question 25

myocarditis

Answer 25

-primary myocarditis caused by acute viral infection or post viral immune response

infectious causes
-viruses (most common)*

noninfectious causes

• chemo drugs
• autoimmune diseases
• hypersensitivity rxns

diagnosis

• high WBC, ESR, CRP, troponin, BNP
• need biopsy and histologic evidence

Question 26

what can lead to cardiotoxicity in noninfectious myocarditis?**

Answer 26

• COCAINE**
• causes coronary spasm, MI, arrhythmias, myocarditis
• inhibits NE reuptake by sympathetic nerves