Congestive Heart Failure

Question 1

What are the causes of left sided heart failure?

Answer 1

Ischemia, HTN, dilated cardiomyopathy, MI, restrictive cardiomyopathy

Question 2

What causes the clinical features of left sided heart failure?

Answer 2

Decreased forward perfusion and pulmonary congestion

Question 3

What does pulmonary congestion in left sided heart failure lead to? What does this result in?

Answer 3

Pulmonary edema which results in dyspnea, paroxysmal nocturnal dyspnea, orthopnea and crackles

Question 4

What is seen on histology in pulmonary congestion due to left sided heart failure?

Answer 4

Small congested capillaries may burst, leading to intraalveolar hemorrhage marked by hemosiderin-laden macrophages (heart failures cells)

Question 5

What does decreased flow to kidneys in left sided heart failure lead to?

Answer 5

Activation of renin-angiotensin system. Fluid retention exacerbates CHF.

Question 6

What is the treatment for left sided heart failure?

Answer 6

ACE Inhibitor

Question 7

What is the treatment for left sided heart failure?

Answer 7

ACE Inhibitor

Question 8

What is the main cause of righ sided heart failure? What are other important causes?

Answer 8

Left sided heart failure. Other important causes include left-to-right shunt and chronic lung disease (cor pulmonale)

Question 9

What are the clinical features of right sided heart failure and what causes them?

Answer 9

Congestion causes them.
1. Jugular venous distention 2. Painful hepatosplenomegaly with characteristic ‘nutmed’ liver which may lead to cardiac cirrhosis. 3. Dependent pitting edema (due to increased hydrostatic pressure)