Congestive Heart Failure Flashcards
Is congestive heart failure caused by systolic
dysfunction, diastolic dysfunction, or both?
Congestive heart failure is usually associated with systolic
dysfunction, which occurs when the heart is unable to pump an
adequate amount of blood to meet the metabolic requirements
of the body. But, symptoms of heart failure can also occur with
diastolic dysfunction as a result of atrial hypertension.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 365-366.
The left ventricle is most commonly involved in
systolic heart failure, and often the right ventricle is
involved secondarily, but in what instances is systolic
heart failure associated with isolated right ventricular
failure?
Advanced disease of the lung parenchyma or pulmonary
vasculature
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 365.
What are the most common causes of left ventricular
failure?
Primary myocardial dysfunction associated with coronary artery
disease is the most common culprit, but valvular disease,
arrythmias, and pericardial disease are also causes of left
ventricular failure.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 205.
How does ventricular dilation help compensate for
chronic heart failure?
As heart failure ensues, the ejection fraction decreases. As the
left ventricle dilates, it accommodates more volume. Thus, the
same ejection fraction of an increased volume will still be a
normal stroke volume. As venous congestion and ventricular
dilatation continues, however, clinical deterioration will
eventually occur.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 367.
How are the mixed venous oxygen tension and
arteriovenous oxygen content difference affected by
heart failure?
The mixed venous oxygen tension is decreased and the
arteriovenous oxygen content difference is increased. In
compensated heart failure, the arteriovenous oxygen content
difference may be normal, but increases rapidly with any form of
cardiac stress.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 366.
What are the major compensatory mechanisms in
the presence of heart failure?
Increased preload and sympathetic tone, activation of the reninangiotensin
system, and ventricular hypertrophy are the
compensatory mechanisms that occur in the presence of heart
failure.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 367-368.
How does right ventricular failure lead to ascites?
As the right ventricle fails, venous congestion leads to systemic
venous hypertension, which results in peripheral edema,
hepatic congestion, and ascites.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 367.
In patients with chronic congestive heart failure,
ventricular dilation occurs as a compensatory
mechanism to allow for ejection of sufficient stroke
volume. The relationship that predicts the increase
in ventricular wall stress as this dilation occurs is
attributed to whose law?
LaPlace’s relationship states that wall tension is proportional to
the product of intraventricular pressure and ventricular wall
radius.
Shubert, D & Leyba, J. Chemistry and Physics for Nurse
Anesthesia: A Student Centered Approach. 2nd Ed. New York:
Springer Publishing Company; 2013: 183-186.
What is the ‘triple therapy’ that is the mainstay of
pharmacologic treatment of congestive heart failure?
The triple therapy drug regimen used for patients with
congestive heart failure consists of an ACE inhibitor, a betablocker,
and a diuretic (which is often an aldosterone
antagonist).
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 205.
Heart failure is most commonly associated with a
decrease in cardiac output, but in what instance is it
associated with an increased cardiac output?
Sepsis, or any other hypermetabolic state associated with a
severe decrease in the systemic vascular resistance can result
in high cardiac output heart failure.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 367.
Are norepinephrine levels increased or decreased in
patients with congestive heart failure?
In congestive heart failure, sympathetic activation is increased,
which results in increased secretion of norepinephrine.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 367.
How are vasopressin levels affected by congestive
heart failure?
Circulating vasopressin levels are nearly twice the normal value
in patients with congestive heart failure.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 367-368.
How do circulating catecholamine levels correlate
with the severity of congestive heart failure?
Circulating catecholamine levels increase in direct proportion to
the severity of left ventricular dysfunction.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 367
How are catecholamine receptors affected by
congestive heart failure?
Because of the chronically increased levels of circulating
catecholamines associated with congestive heart failure, the
response of adrenergic receptors is diminished (downregulated).
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 367
What electrolyte abnormalities are often present in
patients with congestive heart failure?
Patients with congestive heart failure often exhibit hyponatremia
due to activation of the vasopressin system. Treatment with
diuretics to reduce vascular fluid volume may also lead to
hypokalemia and hypomagnesemia.
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s
Clinical Anesthesiology. 5th ed. New York, NY: McGraw-Hill;
2013: 367-368.
