CPR 7.01, 7.11, 7.12 Heart Failure

Question 1

Name 4 broad causes of extremity edema.

Answer 1

Increased CHP, Decreased Plasma oncotic pressure, Increased filtration constant, Lymphatic injury or blockage

Question 2

Name 2 broad categories of causes for pulmonary edema

Answer 2

Cardiogenic and Non-Cardiogenic

Question 3

Systolic heart failure will have what effect on SV, ESV, EDV, PCWP, and compliance?

Answer 3

• Decreased SV
• Increased ESV
• Increased EDV
• Increased PCWP
• Increased Compliance

Question 4

How will reducing after load in the presence of systolic dysfunction affect ejection velocity?

Answer 4

With the decreased isotropy present in heart failure there is reduced ejection velocity.
Reducing after load attenuates this decrease by restoring velocity of fiber shortening and thus ejection velocity and SV.

Question 5

Name 2 main methodologies for producing diastolic dysfunction.

Answer 5

Reduced Structural compliance

Reduced functional compliance

Question 6

Diastolic heart failure will have what effect on Compliance, EDV, EDP, PCWP, SV?

Answer 6

• Reduced ventricular compliance and EDV
• Increased EDP and PCWP
• Decreased SV

Question 7

In combined systolic/diastolic dysfunction, what will be the effect on SV, ESV, EDV, EDP, PCPW, and stroke work?

Answer 7

Decreased SV, Increased ESV, Decreased EDV, increased EDP, Decreased SV, EF, and Stroke work, Increased PCPW

Question 8

What are some of the main effects seen with enhanced sympathetic stimulation in HF?

Answer 8

Increased HR, SV and CO, enhances arrythmogenesis, stimulates remodeling, triggers molecular and biochemical changes that lead to dysfuncion, ↑ SVR, ↓ Venous compliance.

Question 9

What are some of the main effects seen with enhanced RAAS stimulation (ANG-II) in HF?

Answer 9

↑ SVR, Aldosterone release, Ventricular remodeling

Question 10

What happens with ANP and BNP in heart failure and what is their function?

Answer 10

ANP and BNP increase in heart failure. Counterregulate RAAS system. BNP is diagnostic for CHF.

Question 11

What effects do increased circulating levels of vasopressin have in HF?

Answer 11

Arterial vasoconstriction, Increased blood volume.

Question 12

How many people in the US have heart failure and what is the 5 year survival rate?

Answer 12

5.1 million people. 50% survival rate.

Question 13

How have defibrillators increased the number of patients discharged with HF?

Answer 13

They are good at preventing death from arrhythmia.

Question 14

In a pt. with heart failure, how will the SV or CO be altered in terms of its responsiveness to LAP? Result of this?

Answer 14

Smaller increase in Stroke Volume (CO) per increase in LVEDP (LAP) in heart failure. Leads to left heart failure and pulmonary congestion.

Question 15

How does the body attempt to compensate for Left sided heart failure and what are some of the side effects of this?

Answer 15

A. High filling pressures on the left side is an attempt to maintain cardiac output. But results in: 1. Fluid in alveoli→ Pulmonary edema and dyspnea2. Poor distal perfusion including ↓ GFR, ↓ extremity perfusion.

Question 16

What occurs in right sided heart failure and what are some of the systemic consequences?

Answer 16

A. Fluid builds up behind RV→ High filling pressures on the right side which causes: 1. Hepatomegaly, JVD, Peripheral edema.

Question 17

Describe the 4 classes of New York Heart Association classification system and when this is more reliable

Answer 17

A. Class 1: Patient not symptomatic with ordinary physical activity. Only symptomatic with extreme activity. B. Class II: Symptomatic with ordinary physical activity. C. Class III: Symptomatic with only mild physical activity. D. Class IV: Symptomatic even at rest, exacerbated by any physical activity. better for acute situation, but not as reliable for long term prognosis.

Question 18

Describe the 4 stages of the ACC/AHA HF classification system and when this is more reliable.

Answer 18

A. Stage A: high risk for HF but no signs/sxB. Stage B: structural heart disease without signs/sx. C. Stage C: structural heart disease with prior or current sx of HF. D. Stage D: refractory HF requiring interventions. especially for long term prognosis and used for research.