Congestive Heart Failure

Question 1

heart failure: def

Answer 1

clinical SYNDROME in which abnormal heart function results in symptoms/signs of low cardiac output and/or pulmonary/systemic congestion

Question 2

what is the low cardiac output from? congestion?

Answer 2

inadequate forward low. excessive fluid back up

Question 3

classification of heart failure

Answer 3

HF rEF or HF pEF. acute or chronic, congestive or low output, right or left

Question 4

what is the main cause of HF rEF vs. pEF?

Answer 4

rEF = decreased emptying, systolic dysfunction. pEF = decreased filling, diastolic dysfunction

Question 5

causes of HF rEF?

Answer 5

loss of muscle (MI). volume/pressure overload for many years (regurgitation or stenosis). decreased contractility

Question 6

causes of HF pEF

Answer 6

decreased filling from: hypertension, cardiomyopathy, valve stenosis, tamponade

Question 7

sequence of events in HF rEF

Answer 7

damaged ventricle so decreased ejection fraction aka decreased stroke volume. with each heart beat, LV size increases, Starling’s law restores stroke volume close to normal but that requires a bigger heart. increase in LV filling pessure

Question 8

sequence of events in HF pEF

Answer 8

stiff ventricle that empties well but has poor filling = decrease stroke volume at normal pressures. increase LV filling pressure to keep normal stroke volume

Question 9

simply speaking, HF rEF is a ____ problem? HF pEF?

Answer 9

rEF (systolic) = volume overload. pEF (diastolic) = pressure overload problem.

Question 10

anatomical approach to heart failure causes (4)

Answer 10

pericardium (constrictive pericarditis, tamponade). coronary arteries (MI). myocardium (primary diseases, infiltration). endocardium (Valve regurgitation or stenosis)

Question 11

5 patholophysiological approaches to heart failure causes

Answer 11

increased metabolic demands (anemia, infections, hyperthyroid). increased preload. increased afterload. decreased contractility. increase heart rate (or very slow HR)

Question 12

8 adaptive changes in heart failure

Answer 12

Frank Starling mechanism. vasoconstriction. catecholamines. natriuretic peptides. ventricular remodeling. autonomic regulation. RA-aldosterone. ADH.

Question 13

types of hypertrophy and what leads to it

Answer 13

HF-rEF = volume overload = eccentric hypertrophy. pEF = pressure overload = concentric hypertrophy

Question 14

why does hypertrophy happen

Answer 14

too much tension –> occurs as per laplace’s law

Question 15

explanation for hypertrophy with HF pEF

Answer 15

increased pressure = increased tension. adapt by increasing wall thickness and decreasing radius (concentric)

Question 16

explanation for hypertrophy with HF rEF

Answer 16

increased volume so increased radius and increased tension. adapt by increasing wall thickness = reduces tensions (eccentric)

Question 17

transmyocardial pressure gradient equal to?

Answer 17

epicardial coronary pressures minus LV diastolic pressures

Question 18

consequences of LV back pressure of LA?

Answer 18

LA thin walled so can’t hypertrophy = huge increase in pressure = increase in size. risk of short circuits = atrial fibrillation, clots

Question 19

increased afterload in HF adapative?

Answer 19

increase vascular tone and salt/water retention = better organ perfusion. but this also increases MAP and dilates the LV so increases afterload = systolic wall stress

Question 20

3 maladaptations of increased inotrophy

Answer 20

increased oxygen demand. chronically upregulated SNS. ventricular remodeling