Cardiology and heart failure

Question 1

Give a brief anatomy of the heart

• where it is situated
• the chambers
• membrane

Answer 1

Situated behind the sternum in the mediastinum. 1/3 lies to the right of the midline, 2/3 lie to the right.
Divided into 4 chambers
- 2 atria (receiving chambers)
- 2 ventricles (pumping chambers)
Surrounded by a protective double membrane called the pericardium

Question 2

What are the roles of the valves in the heart and name them

Answer 2

Ensure blood flows in one direction
Atrioventricular valves
 - tricuspid valve (R)
 - bicuspid valve (L)
Semilunar valves
 - pulmonary valve (R)
 - aortic valve (L)

Question 3

What is heart failure and how can it progress?

Answer 3

The heart is unable to pump all the blood returned to it. It is either unable to meet the metabolic needs of the body or can only do so with elavated atrial filling.
If untreated left-ventricular failure (LVF) will lead to right-ventricular failure (RVF)

Question 4

How does the incidence of chronic heart failure progress with age?

Answer 4

incidence double with every decade of life.
present in 10% of of people over 70.
50-60% of pts die within 5 years of diagnosis.

Question 5

What does the Frank Starling law state?

Answer 5

the stroke volume of the heart increases in response to an increase in the volume of blood filling the heart when all other factors remain constant.

Question 6

Give the pathophysiology of heart failure

Answer 6

• decreased SV due to impairment of systolic function of left ventricle
• ejection fraction is reduced
• starling law curve moves down
• SV and CO are reduced
• decreased blood being pumped around the body

Question 7

What are the two types of left-sided heart failure?

Answer 7

1. Systolic failure

2. Diastolic failure

Question 8

How does systolic failure occur?

Answer 8

pumping problem

• contraction of the muscle wall of the left ventricle malfunctions
• compromises the pumping function
• decreases the ejection fraction
• overtime this causes enlargement of the ventricle

Question 9

How does diastolic failure occur?

Answer 9

filling problem

• left ventricle wall is unable to relax normally because the muscle has become stiff
• heart does not fill properly
• ejection fraction remains the same
• SV is reduced

Question 10

Give some causes of left-sided heart failure

Answer 10

• cardiovascular disease
• increased after-load hypertension
• increased pre-load mitrial
• obesity
• type 2 diabetes

Question 11

Give some causes of right-sided heart failure

Answer 11

• most common cause is LVF

- cor pulmonale

Question 12

What is cor pulmonale and what are the most common causes?

Answer 12

Dilation and hypertrophy of the right ventricle in response to diseases of the pulmonary vasculature (any condition that affects the blood vessels along the route between the heart and lungs) and/or lung parenchyma (the substance of the lung outside of the circulatory system that is involved with gas exchange)

Question 13

What is pulmoary oedema, what is its main symptom and what secretions does it produce?

Answer 13

Extra vascular water in the lungs
Main symptom is dyspnoea
Pt produces white or pink frothy secretions.

Question 14

What are some management techniques for heart failure?

Answer 14

• healthy lifestyle changes
• cardiac rehab
• medication
• control of heart rhythmn - pace maker
• surgery

Question 15

Describe the New York heart failure classification

Answer 15

Class I (mild)
 - no limitation of physical activity by symptoms
Class II (mild)
 - symptoms with ordinary activity
Class III (moderate) 
 - symptoms with minimal activity
Class IV (severe)
 - symptoms at rest

Question 16

Give the 2 types of valves available through surgery and who they are most suited for

Answer 16

Mechanical valve - suitable for younger pts.
- last a long time 10-20 years
- pts must be on anticoagulants for the rest of their lives
Biological - older pts
- porcine valves or bovine pericardium

Question 17

Name 2 types of heart surgery

Answer 17

1. Open heart surgery

2. Port Access - smaller incision

Question 18

Describe the electrical conductivity system of the heart

Answer 18

Contraction initiated at the SA node in the R atrium.
SA node causes depolarization and contraction of both atria (atrial systole)
Impulse spreads through both atria to the AV node.
AV node slows impulse down and allows time for atrial contraction and ventricular filling
Impulse passes to the bundle of His and Purkinje fibres which causes the depolarozation and contraction of both ventricles (ventricular systole)

Question 19

What is a pacemaker and what does it do

Answer 19

A small device that is placed in the chest or abdomen to help control abnormal heart rhythms.
Uses electrical pulses to prompt heart to beat at a normal rate.
Used to treat arrythmias

Question 20

What precautions must pts with pacemakers take?

Answer 20

Strong electromagnetic fields can interfere with pacemakers (induction hob)
Keep mobile phones 15cm away from pacemakers
Avoid wearing magnet necklaces

Question 21

Give some signs and symptoms of LVF

Answer 21

signs:
 - bibasal pulmonary crackles
 - hart murmur
 - tachycardia (heart rate over 100 bpm)
 - hypotension
symptoms:
 - dyspnoea
 - wheeze
 - fatigue
 - palpations
 - dizziness

Question 22

Give some signs and symptoms of RVF

Answer 22

signs:
 - pitting
 - pulmonary oedema
 - tachycardia (heart rate over 100 bpm)
 - hypotension 
symptoms:
 - dyspnoea
 - ankle swelling
 - aneorexia
 - fatigue
 - dizziness