Congestive Heart Failure 2

Question 1

diastolic dysfunction is when LV? why?

Answer 1

can’t fill at a normal pressure: decreased chamber compliance (hypertrophy, fibrosis, pericardial constraint) or poor relaxation (ischemia, hypertrophy)

Question 2

trigger and response of the sympathetic NS?

Answer 2

reduced effective circulating volume sensed by central baroreceptors = activate sympathetic neural tone, and secretion of catecholamines

Question 3

adaptive effects of sympathetic NS?

Answer 3

increased heart rate, increased contractility. increased afterload (not that good). increased preload

Question 4

trigger and response of renin angiotensin aldosterone system

Answer 4

decreased perfusion in pressure sensed by kidney = renin…aldosterone

Question 5

adaptive effects of RA/aldosterone

Answer 5

increased afterload b/c vasoconstrcition. increased b/c fluid retention. also minorly increases HR and contractility since it activates SNS

Question 6

maladaptive effects of RA/aldosterone

Answer 6

volume overload. vasoconstriction (so increased afterload). increase in ECM in heart aka fibrosis = chamber stiffness. more endothelial dysfunction

Question 7

ADH trigger and response

Answer 7

carotid/aortic arch baroreceptors sense decreased volume - ADH released from post pit.

Question 8

adapative effects of ADH

Answer 8

afterload increased by increasing vascular tone. preload increased by water retention

Question 9

natriuretic peptides trigger and response

Answer 9

atrial/ventricular stretch = ANP/BNP released by the heart

Question 10

effects of natriuretic peptides

Answer 10

decreased afterload because vasodilation. decreased preload b/c venodilation, diuresis.

Question 11

neprilysin inhibitor does what

Answer 11

neprilysin normally breaks down natriuretic peptides so now more NPs = more diuresis etc.

Question 12

heart failure is a condition of _____ but _____?

Answer 12

increased body water (intravascular, interstitial). but decreased EFFECTIVE circulating volume (poor cardiac output)

Question 13

symptoms of heart failure: two main categories

Answer 13

high preload = congestion, peripheral and pulmonary edema = SOB, orthopnea, PND, early satiety, abd distension, nausea. low cardiac output = fatigue, exercise intolerance = SOB, SOBOE, weakness

Question 14

clinical profiles of acute heart failure: I, II, III, IV?

Answer 14

I = warm and dry aka not congested, good perfusion. II = warm and wet. III = cold and dry. IV = cold and wet

Question 15

why are patients with heart failure short of breath

Answer 15

stiff lungs (increased fluid in capillary bed secondary to increased backpressure). hypoxemia because less oxygen exchange. impaired resp muscles b/c low blood flow to them from low cardiac output

Question 16

mechanisms of edema (4)

Answer 16

less oncotic pressure in capillaries (less albumin, more protein loss). increased hydrostatic pressure in capillaries (increased venous pressure or increased volume). lymphatic obstruction. increased capillary permeability (inflamm or infection)

Question 17

4 investigations in heart failure

Answer 17

ECG. CXR. echocardiogram. BNP

Question 18

ECG findings heart failure

Answer 18

left ventricular (maybe atrial as well) hypertrophy. atrial fibrillation. conduction abnormalities.

Question 19

CXR and echocardiogram findings in failure

Answer 19

XR: cardiomegaly. echo: chamber size and function, valves, pericardial effusion, intracardiac pressures

Question 20

BNP findings in heart failure. caveats? use it for?

Answer 20

> 500 pg/mL = HF, <100 probably not. high in renal failure and sepsis, low in obese patients, mitral stenosis, tamponade. half life 20 hours. use it to diagnose HF when cause of dyspnea is unclear