Cardiovascular- CHF

Question 1

Diagnosis: Dyspnea, orthopnea, pitting edema, holosystolic @ cardiac apex, Lateral displace maximal impulse.

Answer 1

Decompensated Heart failure due to Left ventricular systolic dysfunction

Question 2

Left ventricular systolic dysfunction changes to cardiac physiology

Answer 2

↓ CO (contractile dysfunction))
↑ SVR (reflexive)

↑Pulmonary capillary wedge pressure
↑Central venous pressure
↑ LVEDV

Question 3

High output heart failure changes to cardiac physiology

Answer 3

↓SVR
↑Central venous pressure
↑Pulmonary Wedge pressure

↑LVEDV
Normal/ ↑CO

Question 4

Mechanism of high output heart failure

Answer 4

Reduced SVR increases CO and allows blood to return to return to heart quickly. LV unable to keep up with increased return

Question 5

Mechanism of decompensated HF progression to cariogenic shock

Answer 5

↓CO –> ↓ Renal perfusion –> ↑RAAS –> ↑Vasoconstriction and retention –> worsening CO

Eventual hypotension and reduced organ and tissue percussion= shock

Question 6

Brain natruiertic peptide (BNP)

Answer 6

Released from the ventricular myocardium in response to myocardial stretch caused by volume and pressure overload

Question 7

Ruling out heart failure with BNP

Answer 7

A serum BNP level >100 pg/mL is highly sensitive for heart failure (ie, most patients with heart failure have an elevated serum BNP);

therefore, a low serum BNP level (<100 pg/mL) is highly useful in ruling out heart failure.

Question 8

BNP and obese patients

Answer 8

BNP can be falsely low in patients with heart failure and obesity because BNP undergoes increased clearance by fat cells.