Chronic Heart Failure Lec

Question 1

Chronic Heart Failure:

” a syndrome where the heart is ___________

Background & Diagnosis

Answer 1

Heart cannot supply enough oxygen rich blood to the body and its vital organs.

• problem with filling the left ventricle (relaxation = diastole)
  [ventricle may be stiff and not able to fill well]
• problem with ejection of blood from the left ventricle (contraction = systole) “more common”
• it is a problem with demand and supply

Question 2

We diagnosis Heart Failure with one main test:

Answer 2

(ECHO) echocardiogram = an ultrasound of the heart

When we do an ECHO, we are looking at the heart, seeing how it is performing. The thing we are looking at is the ejection fraction.

Question 3

An (EF) Ejection fraction of _______________________ is heart failure with reduced ejection fraction. Which is also called _______

Answer 3

< less than 40%

systolic dysfunction “since the problem here lies with the contraction of the heart”

Question 4

Ejection fraction (EF) =

Answer 4

the blood pumped from the ventricle during each contraction.

Question 5

(HFrEF) Heart Failure with reduced Ejection Fraction:

Also called ________

Answer 5

Systolic Heart Failure

• weakened heart muscle around ventricle
• contractions are weak “can’t squeeze as well as it should”
• less blood pumped out of ventricles
• EF < 40%

Question 6

(HFpEF) Heart Failure with preserved Ejection Fraction:

Also called _________

Answer 6

Diastolic Heart Failure

• muscle around ventricle has become thickened & very stiff from working so hard
• the interior cavity of the ventricle has reduced in size
• the ventricle can not fill up as well as it has before

Question 7

A normal ejection fraction in someone who does not have heart failure is ___________

Answer 7

55-70%, in other words, we do not completely empty the ventricle during a contraction.

Question 8

General Signs & Symptoms of Systolic Heart Failure:

-
-
-
-

Answer 8

• EF < 40%
• 2 labs that help us a little bit: increased BNP & increased NT-proBNP. These are both elevated in conditions that cause the ventricles to stretch & work harder. Anything related to fluid overload can cause.
• SOB “shortness of breath” orthopnea, dyspnea
  (these are due to fluid overload)
• cough
• weakness/fatigue
• fluid overload (edema, ascites, Jugular Venous Distention, HepatoJugular Reflux)

-

Question 9

BNP and proBNP are used to distinguish between _________ and ________ causes of dyspnea.

Answer 9

cardiac

non-cardiac

Question 10

Signs & Symptoms of Systolic Heart Failure:

What are the Left-Sided Signs & Symptoms

Question 11

Signs & Symptoms of Systolic Heart Failure:

What are the Right-Sided Signs and Symptoms?

Question 12

Orthopnea

Answer 12

shortness of breath when you lie down

Question 13

Dyspnea

Answer 13

shortness of breath when exerting oneself

Question 14

(BNP)

what this indicates:

Common reference range:

Answer 14

B-Type Natriuretic Peptide

• maker for cardiac stress
• is not heart failure nor heart disease specific, BUT higher values indicate higher likelihood of HF when consistent with HF symptoms. Renal failure is the second most common cause of increased BNP & NT-proBNP

< 100 ng/L or pg/mL

Question 15

(NT-proBNP)

what this indicates:

Common reference range:

Answer 15

N-Terminal-ProBNP

• marker for cardiac stress
• is not heart failure nor heart disease specific, BUT higher values indicate higher likelihood of HF when consistent with HF symptoms. Renal failure is the second most common cause of increased BNP & NT-proBNP
• normal < 300pg/mL

Males: < 61pg/mL
Females: 12-151pg/mL

Question 16

There are a couple different classification systems for systolic heart failure:

-

-

Answer 16

(ACC/AHA) American College of Cardiology & American Heart Association Staging System
- A-D (A, being least sick patient & D being most sick patient)
- addresses patients who do NOT yet have structural heart disease or symptoms of HF, but who are at high risk

(NYHA) New York Heart Association Functional Classes (FC)
- I-IV (I, being the least sick patient & IV being the most sick patient)
- Soley Based on symptoms
- Clinical Trials historically enrolled patients based on NYHA FC

Question 17

NYHA Functional Class I

criteria

Question 18

NYHA Functional Class II

criteria

Question 19

NYHA Functional Class III

criteria

Question 20

NYHA Functional Class IV

criteria

Question 21

ACC/AHA Staging System, Stage A

criteria

give examples of patients in class

Question 22

ACC/AHA Staging System, Stage B

criteria

Question 23

ACC/AHA Staging System, Stage C

criteria

Question 24

ACC/AHA Staging System, Stage D

criteria

Question 25

The Compensatory mechanisms used in Heart Failure:

1.

2.

3.

4.

Answer 25

1. Activation of (SNS) Sympathetic Nervous System X(bad)
2. Activation of (RAAS) Renin Angiotensin Aldosterone System X(bad)
3. Increase Vasopressin (ADH) X (bad)
4. Increase/Activation of Natriuretic Peptides (good compensatory mechanism)

Question 26

What Effect does the compensatory mechanism have?

1. Activation of (SNS) Sympathetic Nervous System

Question 27

the faster that heart is beating, the less effective it will be able to contract and eject blood

Question 28

What Effect does the compensatory mechanism have?

2. Activation of (RAAS) Renin Angiotensin Aldosterone System

Question 29

What Effect does the compensatory mechanism have?

3. Increase Vasopressin (ADH)

Question 30

What Effect does the compensatory mechanism have?

4. Increase/Activation of Natriuretic Peptides

Question 31

(CO) Cardiac Output

define:

Equation:

Answer 31

• is the volume of blood that is pumped by the heart in one minute
  “the amount of blood that comes out of ventricle during systole”

CO = HR(heart rate) x SV(stroke volume)

Question 32

The problem of heart failure is decreased _____________

Answer 32

cardiac output

Question 33

systole:

Answer 33

contraction of ventricles

Question 34

diastole:

Answer 34

relaxation of ventricles

Question 35

Lifestyle management for Patients with Heart Failure very important: