congestive heart failure

Question 1

CHF is the end point of

Answer 1

cardiovascular diseases

Question 2

CHF is complex and leads to

Answer 2

multi-organ failure

Question 3

CHF is an example of what shock

Answer 3

cardiogenic- shock induced by an alternation in cardiac function

Question 4

heart is not pumping adequately to lungs, throughout chambers, into aorta and body, this results in:

Answer 4

cardiac (within heart chambers), pulmonary, and systemic congestion
-blood POOLS, still flows but not adequately

Question 5

etiology of CHF

Answer 5

• CAD (atherosclerosis)
• cardiomyopathy
• uncontrolled HTN
• valvular disease

Question 6

risk factors for HF (A LOT)

Answer 6

• htn
• ischemic heart disease
• type 2 diabetes and metabolic syndrome
• hyperlipidemia
• smoking
• obesity
• older age
• sex
• ethnicity
• physical inactivity
• excessive ETOH, salt
• cardiotoxic agents
• family hx/genetics
• low EF, impaired diastolic

Question 7

basically CHF can be produced by any condition that…

Answer 7

reduces pumping ability of heart

Question 8

in a health person the heart workload can increase 5-fold but in CHF…

Answer 8

heart does not have the same adaptability—> cardiac reserve is used up at rest, so if there is increased metabolic demand, heart will NOT cope

Question 9

often times which part of heart fails?

Answer 9

left ventricle, which results in decreased CO to systemic circuit
-results in residual volume in chamber

Question 10

failure of the left ventricles results in…

Answer 10

congestion within the pulmonary circuit, then the right ventricle must work harder to pump blood to lungs and HYPERTROPHY occurs within RV myocardium

Question 11

summarize what happens in left-sided failure

Answer 11

• insufficient CO—> residual volume in left ventricle —> left atrium pumps harder to empty —> notenough space for left atrium to empty, so residual volume in left atrium
• left atrium unable to receive full pulmonary return—> increased CHP in pulmonary circuit—> pulmonary congestion (edema in interstitial spaces and alveoli)—> increased workload of right ventricle—> hypertrophy of right ventricle —-> right sided failure (usually)

Question 12

summarize what happens in right-sided failure

Answer 12

failure to eject blood into pulmonary circuit= pooling in systemic circuit (manifests as peripheral edema and abdominal organ distention)

Question 13

general rule of HF

Answer 13

ANY CHAMBER being pumped to NOT getting enough blood and any chamber RECEIVING blood is congested

Question 14

why is the patient asymptomatic at the beginning of CHF?

Answer 14

the patient has compensation mechanisms that are kicking in! 6

Question 15

name the SIX compensatory mechanisms for CHF

Answer 15

• frank-starling law
• SNS
• RAAS
• ANP and BNP
• endothelins
• cardiac hypertrophy and remodelling

Question 16

what is the frank-starling law?

Answer 16

-more the heart is stretched, the more blood is filled, which increases venous return= increased end-diastolic volume= increased preload= increased cardiac output
BUT, if heart is consistently stretched, it will lose contractility… decreases CO and when there is decreased CO, more O2 is needed… SNS kicks in

Question 17

SNS does what..

Answer 17

aims to increase cardiac output by causing tachycardia and systemic vasoconstriction (BV not affected)
-but, increased contractility, increased workload and O2 demand can advance the heart failure

Question 18

RAAS is triggered by…

Answer 18

the decrease in CO and renal perfusion—> angiotensin II= patent vasoconstrictor, increases BP and increases CO
-releases ADH and aldosterone—> fluid retention (increased BV, CO)

Question 19

what are ANP and BNP

Answer 19

both are natriuretic peptides
anp= atrial natriueretic peptide, secreted by heart muscle cells
bnp= brain natriuretic peptide, released by ventricles of heart in response to excessive stretching of heart muscle cells

Question 20

what do ANP and BNP cause…

Answer 20

potent diuresis and natriuresis (secrete H20 and NA)—> decrease blood volume, decrease workload of the heart—-> decreased BP

• VASODILATOR
• OPPOSITE of SNS and RAAS

Question 21

endothelins do what?

Answer 21

vasocsontrictors released by epithelial and cardiac muscle cells in wall of vessels—> increase BP
-release growth factors that cause vascular and cardiac muscle hypertrophy—> larger muscle require more resources (more O2 or die)

Question 22

cardiac hypertrophy and remodelling?

Answer 22

• increased workload causes hypertrophy—> eventually decreased contractility—> requires more O2—> myocardial dysfunction, EVENTUALLY
• compensation leads to DECOMPENSATION and FAILURE

Question 23

manifestations of CHF?

Answer 23

• vary depending on severity and type, signs and symptoms are related to effects of impaired pumping
• hypoperfusion, hypoxia, acidosis all due to congestion

Question 24

symptoms in compensatory phase?

Answer 24

ASYMPTOMATIC

Question 25

diagnosis of CHF?

Answer 25

EASY and comprehensive: history---> look at risk factors, lab values----> anemia, electrolyte, renal fx, hematology (liver fx) - ECG- possibly persistent in acute - echocardiogram: shows hemodynamics

Question 26

treatment of CHF?

Answer 26

- acute: stabilize pt and correct the cause (MI---> anticoagulant, thrombolytic, antiarrhythmic, O2, morphine) - chronic: symptomatic management; decrease risks, increase functioning, rest

Question 27

what is systolic HF and how do u treat it?

Answer 27

EF is less than 40: treat with ace inhibitor and beta blocker to increase EF

Question 28

if EF is 40% or more than...

Answer 28

treat cause (eg. diabetes), ace inhibitor w/ or w/o beta blocker - angiotensin receptor blocker if pt has symptoms with activity - diuretic is pt has symptoms at rest

Question 29

surgery for HF?

Answer 29

stenting, fix valvular defect