CHF 3/13

Question 1

Congestive Heart Failure (CHF) is defined as:

Answer 1

“A clinical syndrome in which abnormalities of ventricular function and neurohormonal regulation lead to pulmonary venous congestion, exercise intolerance, and decreased life expectancy.”
CHF is a problem with:
- forward ejection
- myocardial failure
- impaired cardiac filling o volume overload

Question 2

1. what is LV Remodeling?
2. what causes it?
3. what is the prognosis?

Answer 2

1. Mechanical, neurohormonal, and possibly genetic factors alter ventricular size, shape, and function
2. It occurs in most heart diseases, including MI, cardiomyopathy, hypertension, aging, diabetes, and valvular heart disease.
3. Remodeling can be reversed, or at least delayed (ace inhibitors work well), improvement in the remodeling process is associated with improvement in patient outcomes.

Question 3

1. what is Concentric hypertrophy?
2. what diseases cause it?
3. what type of dysfunction (systolic or diastolic)

Answer 3

1. Due to chronic PRESSURE overload from thicker LV wall with normal chamber size or “stiff” LV
2. HTN, Aortic Stenosis, coarctation of aorta
3. DIASTOLIC dysfunction (ventricle is too stiff or thick to relax)

Question 4

1. what is Eccentric hypertrophy
2. what causes it?
3. what type of dysfunction (diastolic and systolic)

Answer 4

1. Due to chronic VOLUME overload; will Dilated LV Wall with dilated chamber size; “globular” LV
2. Chronic aortic regurgitation, mitral regurgitation, morbid obesity
3. SYSTOLIC dysfunction (the heart is too dilated to squeeze properly).

Question 5

the American College of Cardiology/American Heart Association working group introduced four stages of heart failure

Answer 5

Stage A: Patients at high risk for developing HF in the future but no functional or structural heart disorder.
Stage B: a structural heart disorder but no symptoms at any stage.
Stage C: previous or current symptoms of heart failure in the context of an underlying structural heart problem, but managed with medical treatment.
Stage D: advanced disease requiring hospital-based support, a heart transplant or palliative care.

Question 6

Other classifications of CHF

• right-sided failure

Answer 6

Right: systemic venous congestion due to pulmonary HTN → eventually LV failure due to ↑afterload on RV
Pedal edema JVD
Liver enlargement
 Dyspnea
 Causes
• RV infarction
• Cor pulmonale, Severe Obstructive Sleep Apnea • COPD
• PE

Question 7

Left-sided failure

Answer 7

-Left (*more common): High LVEDP causes pulmonary venous congestion
Dyspnea
Orthopnea
Fatigue, confusion
Nocturia (Improved renal perfusion when supine)

Question 8

What happens to the PV loop in CHF due to decreased contractility?

Answer 8

• the PV loop shifts down (lower pressures) and to the right (higher volumes) due to decreased compliance. The LV cannot generate enough pressure to eject the volume:

Question 9

1. what is right sided CHF
2. what Causes right side CHF
3. s/s/ of right side CHF?

Answer 9

1. Right: systemic venous congestion due to pulmonary HTN → eventually LV failure due to ↑afterload on RV
2. causes of CHF:
   • RV infarction
   • Cor pulmonale, Severe Obstructive Sleep Apnea
   • COPD
   • PE
   -pulm HTN
3. s/s of right side CHF:

Question 10

1. what is left congestive failure?
2. which one is more common (left or right CHF)?
3. what are the s/s of left side CHF?

Answer 10

1. High LVEDP (left ventricular end diastolic pressure) causes pulmonary venous congestion (fluid backs up into lungs).
2. left side CHF is more common
3. s/s of left side chf:

Question 11

what is systolic dysfunction?

Answer 11

Systolic dysfunction

Question 12

what is diastolic dysfunction?

Answer 12

LV diastolic function: Impaired relaxation d/t increased stiffness of the LV causes↓filling and ↓volume but ↑pressures

Question 13

1. what are the Compensatory Mechanisms involved in CHF?

2. in what severity of heart failure are these machanisms able to maintain function?

Answer 13

1. After the onset of the initial stress or abnormality, the body utilizes compensatory mechanisms in an attempt to maintain cardiac pump function.
2. In mild heart failure, these mechanisms are capable of maintaining temporary pump function often restoring a normal arterial blood pressure, organ perfusion and cardiac output.

Question 14

CHF progression (part 1)
 What neurohumoral responses kick in during early chf?

Answer 14

neurohumoral responses are:

• SNS stimulation
• Salt and water retention
• Vasoconstriction

Question 15

1. these responses are initially adaptive but…?

2. what are these symptoms?

Answer 15

1. 2. Eventually, this becomes maladaptive→
2. -Pulmonary congestion
   
   • Excessive afterload

Question 16

1. this causes…?

2. which is manifest as?

Answer 16

1. A vicious cycle
2. Increased cardiac energy expenditure (Cardiac inefficiency)
   - Worsened pump function
   - Decreased tissue perfusion
   - Renal and peripheral symptoms

Question 17

1. what is preload?
2. what determines it?
3. what is the relationship between preload and stroke volume?

Answer 17

1. The tension present in the wall of the LV at end diastole (just before contraction)
2. Determined by VOLUME in the LV
3. When Preload increases, SV is increased