E4. Heart Failure Patho

Question 1

What is the #1 reason for hospital admission in the U.S?

Answer 1

Heart Failure

Question 2

What is the #1 cause of heart failure?

Answer 2

Myocardial Infarction

Question 3

___________ is a decrease in cardiac output

Answer 3

Heart Failure

Question 4

______ is the amount of blood leaving your heart.

Answer 4

Cardiac Output

Question 5

Cardiac Output Equation

Answer 5

SV * HR

Question 6

Flow of blood through the heart.

Answer 6

RA-> RV-> Lungs -> LA-> LV -> Aorta

Question 7

____________ is when not enough blood is pumped to the lungs.

Answer 7

Right-Sided Heart Failure

Question 8

_____ is when not enough blood is pumped to the aorta to perfuse tissues.

Answer 8

Left-Sided Heart Failure.

Question 9

_____ HF is more common.

Answer 9

Left-Ventricular Heart Failure.

Question 10

____ is the fraction of blood that leaves the ventricle.

Answer 10

Ejection Fraction.

Question 11

HFrEF

Answer 11

Heart Failure with reduced ejection fraction.

Question 12

EF <40% is _______________

Answer 12

HFrEF

Question 13

HFmrEF

Answer 13

Heart Failure with mildly reduced ejection fraction.

Question 14

EF 40-50% is ________________

Answer 14

Heart Failure with mildly reduced ejection fraction.

Question 15

HFpEF

Answer 15

Heart Failure with preserved ejection fraction.

Question 16

EF >50% with heart failure is _____________

Answer 16

HFpEF

Question 17

Diastolic Heart Failure is also known as ______

Answer 17

HFpEF

Question 18

____ is when not enough oxygenated blood is moving forward from the heart to perfuse the vital organs.

Answer 18

Hypoperfusion.

Question 19

____ is when blood backs up from the LV to the lungs, possible the RV.

Answer 19

Congestion

Question 20

What are the two major clinical presentations of HF?

Answer 20

1. Hypoperfusion.
2. Congestion.

Question 21

What are these signs of?

Tachycardia, Fatigue, Cyanosis, Cold Extremities, Organ Dysfunction

Answer 21

Hypoperfusion

Question 22

What are these signs of?

Weight gain, SOB, Orthopnea, Paroxysmal nocturnal dyspnea, pleural effusion on CXR, crackles/rales on auscultation, S3 and S4, peripheral edema, BNP, JVD

Answer 22

Congestion

Question 23

ACC Class A Heart Failure

Answer 23

Patient is at risk for structural heart disease and does not have symptoms.

Question 24

ACC Class B Heart Failure

Answer 24

Patient has structural heart disease without symptoms.

Question 25

ACC Class C Heart Failure

Answer 25

Patient has structural heart disease and symptoms.

Question 26

ACC Class D Heart Failure

Answer 26

Patient has structural heart disease and refractory symptoms.

Question 27

NYHA Class I Heart Failure

Answer 27

No limitation on ordinary activity.

Question 28

NYHA Class II Heart Failure

Answer 28

Slight symptoms with activities of daily living.

Question 29

NYHA Class III Heart Failure

Answer 29

Extreme symptoms with activities of daily living.

Question 30

NYHA Class IV Heart Failure

Answer 30

Symptoms even at rest.

Question 31

Heart Failure is diagnosed using _____

Answer 31

Echocardiograms.

Question 32

The pathophysiology of HF is all related through ____.

Answer 32

Baroreceptor activation.

Question 33

What four pathophysiologic responses result from baroreceptor activation in heart failure?

Answer 33

1. Catecholamine Release 2. Juxtaglomerular Apparatus (Renin Release) 3. Sodium and Water Retention 4. Alpha-1 Stimulation.

Question 34

Following baroreceptor activation, what catecholamines are released?

Answer 34

NE and Epi

Question 35

NE and Epi stimulate _____ in the short term.

Answer 35

B-1 receptors in the heart---> this increases cardiac contractility in the short term.

Question 36

NE and EPI release lead to what in the long term.

Answer 36

1. Apoptosis and muscle burn out (Ventricular Remodeling) 2. B-1R desensitization 3. Change in B1:B2 ratio. 4. Uncoupling of B1 Receptors (myocytes don't contract)

Question 37

In HF, how does the ratio of Beta receptors change on the heart?

Answer 37

Changes from 80:20 (B1:B2) to 60:40

Question 38

Following baroreceptor activation, the juxtaglomerular complex releases ____, which stimulates AGII.

Answer 38

Renin

Question 39

What does Angiotensin II production lead to?

Answer 39

1. Vasoconstriction 2. Na and water retention 3. NE and Aldosterone Release 4. Cardiac Remodeling 5. ADH release

Question 40

______ release leads to ventricular remodeling and promotes potassium and magnesium excretion.

Answer 40

Aldosterone

Question 41

In response to baroreceptor activation, ____ receptors are stimulated leading to vasoconstriction. This results in an increase in afterload, making it more difficult for the LV to pump. Overtime this leads to cardiac hypertrophy and remodeling.

Answer 41

Alpha-1-Receptors.

Question 42

What is the #1 cause of death in a patient with HF?

Answer 42

Ventricular tachycardia/fibrillation. (This results from B-1 stimulation and ventricular remodeling).

Question 43

____ is a rapid onset of HF symptoms causing clinic, ED, and hospital admission.

Answer 43

Acute Decompensated Heart Failure (ADHF) --> Heart Failure Exacerbation.

Question 44

What are the three primary causes of ADHF?

Answer 44

1. Noncompliance (diet and medications). 2. NSAID use 3. Comorbidities

Question 45

How do NSAIDs cause ADHF?

Answer 45

Lead to fluid retention

Question 46

What comorbidities may lead to ADHF?

Answer 46

1. Atrial Fibrillation 2. MI 3. Infection

Question 47

Warm

Answer 47

High Perfusion

Question 48

Cold

Answer 48

Poor Perfusion

Question 49

Wet

Answer 49

Congested

Question 50

Dry

Answer 50

Not Congested

Question 51

Class 1 ADHF

Answer 51

Warm and Dry (Perfusing, not congested)

Question 52

Class II ADHF

Answer 52

Warm and Wet (Perfusing and Congested)

Question 53

Class III ADHF

Answer 53

Cold and Dry (Not perfusing and not congested)

Question 54

Class IV ADHF

Answer 54

Cold and Wet (Not perfusing and congested) NOT GOOD!!!!!