CHF

Question 1

What is CHF?

Answer 1

The heart FAILS when it can’t eject blood delivered to it by the VENOUS system.

Question 2

What is the most common hospital admission diagnosis for people >65 years?

Answer 2

CHF

Question 3

What is the most common type of heart failure?

Answer 3

LHFBlood backs up into lungs> pulmonary congestion

Question 4

What happens in RHF?

Answer 4

Blood baks up into the venous system

Question 5

What is LHF?

Answer 5

LV can’t efficiently eject blood into the aorta>INCREASE in left EDV and EDP>

Question 6

What causes pulmonary edema in LHF?

Answer 6

LV can’t efficiently eject blood into the aorta>INCREASE in left EDV and EDP>backup of blood into lungs>pulmonary edema

Question 7

What is systolic heart failure?

Answer 7

Decreased LV contraction

Question 8

What causes systolic heart failure?

Answer 8

1. Ischemia d/t coronary artery atherosclerosis ( most common cause)2. Post MI3. Myocarditis4. Dilated cardiomyopathyALL lead to decreased LV contraction

Question 9

What is diastolic heart failure?

Answer 9

Noncompliant LV w/ impaired relaxation>Increased left ventricle EDP

Question 10

What causes diastolic heart failure?

Answer 10

1. Concentric LVH d/t essential HTN2. AV stenosis3. hypertrophic cardiomyopathy4. restrictive cardiomyopathy (amyloidosis/glycogenosis)

Question 11

What type of heart failure do you suspect in a pt with a LOW EF <40%?

Answer 11

SHF

Question 12

What do you supsect in a pt with a NORMAL EF at rest, and an S4 atrial gallop?

Answer 12

DHFS4 atrial gallop- increased resistance to filling in late diastole

Question 13

What might you find histologically in a pt with LHF?

Answer 13

Heart failure cells: alveolar macrophages with hemosiderin

Question 14

What are some of the clinical sxs that you might see in a pt with LHF?

Answer 14

1. Dyspnea (can’t take full breath)2. pulmonary edema: HP > OP3. Bibasilar inspiratory crackles4. Rust colored sputum5. PND/orthopnea

Question 15

What might you see on a chest xray of someone with LHF?

Answer 15

1. Congestion in the upper lobes2. Perihilar congestion (angel wing configuration)3. Fluffly alveolar infiltrates3. Kerley lines (septal edema)4. Air bronchograms

Question 16

What heart sounds are commonly heard with CHF?

Answer 16

S3 and S4

Question 17

What causes mitral regurgitation often observed with LHF?

Answer 17

Stretching of the MV ring by increased LV EDV >regurgitatnt murmur

Question 18

What is the most useful lab to confirm/exclude LHF?

Answer 18

BNP- cardiac neurohormone secreted from the ventricles when they’re overloaded

Question 19

What is RHF?

Answer 19

RV can’t pump venous blood into the lungs>increased venous hydrostatic pressure

Question 20

What causes RHF?

Answer 20

1. Increase in RV afterload (PH, PV stenosis, saddle embolus)2. Decrease in RV contraction (RV infarction, myocarditis)3. RV is noncompliant (Restrictive cardiomyopathy, concentric RVH)4. Increase in RV preload (TV/PV regurgitation

Question 21

What physical signs/sxs are commonly seen with RHF?

Answer 21

1. Prominence of internal jugular veins2. TV regurgitation (stretching of TV rings from RV volume overload3. Painful hepatomegaly (back up of venous blood into hepatic veins)4. Dependent pitting edema (increased venous HP)5. Cyanosis of mucous membranes (decreased O2 sats)

Question 22

What heart sounds are commonly heard with RHF?

Answer 22

S3 and S4

Question 23

How do you treat CHF?

Answer 23

1. Restrict Na and water2. ACE inhibitor (decrease afterload, decrease preload)3. Beta blocker (decrease myocardial 02 consumption; decrease HR)

Question 24

What is high output heart failure?

Answer 24

When CO is increased compared with values for the normal resting state of the heart

Question 25

What causes HOF?

Answer 25

1. Increase in SV (hyperthyroidism)2. Decreased blood viscosity (severe anemia) > decreases PVR> increases venous return to heart3. Vasodilation of PVR arterioles (septic shock, thiamine deficiency)4. Arteriovenous fistula (increases venous return to heart)