Exam 2 - Heart Failure

Question 1

what is the MC cause of HF?

Answer 1

coronary artery disease

Question 2

what is the MC mechanism of HF?

Answer 2

heart injury from something leads to progressive weakening

Question 3

what is systolic heart failure?

Answer 3

the heart doesn’t contract as well

Question 4

what is diastolic HF?

Answer 4

the ventricles can’t relax as well

Question 5

can systolic HF and diastolic HF occur together?

Answer 5

yes and often do

Question 6

what is the difference between acute and chronic HF?

Answer 6

acute is like a large MI, with sudden symptoms like pulm edema and hypotension

chronic is slow onset of symptoms like peripheral edema and fatigue

Question 7

what is the MC common cause of RHF?

what are other causes?

Answer 7

MC = left-sided heart failure

other: COPD/pulm HTN

Question 8

what are the MC causes of L sided HF?

Answer 8

CAD and HTN

Question 9

what else can cause left-sided heart failure?

Answer 9

post MI

L sided valvular disease

to name some

Question 10

what is backward failure?

Answer 10

ventricles don’t empty correctly and pressure builds up behind ventricles

Question 11

what is forward failure?

Answer 11

poor CO leads to decreased renal perfusion, decreased activation of RAA axis, and Na/H20 retention

Question 12

One of the mechanisms of HF is redistribution of CO. what does this mean?

Answer 12

you have low CO, so your body increases blood flow to vital organs, and decreases blood flow to skin and muscle.

Question 13

When your body redistributes CO, what system does that activate?

Answer 13

sympathetic/adrenergic system

Question 14

Why is it bad that your sympathetic/adrenergic system is activated in HF?

Answer 14

it tries to maintain your BP by increasing cardiac afterload

this makes your weak heart weaker

Question 15

what hormones does you sympathetic system secrete?

Answer 15

epi/NE

Question 16

What does a longterm increase of epi/NE do to your heart?

Answer 16

remodeling

muscle thins, stretches, and dilates

Question 17

Another mechanism of HF is water and Na retention. what “axis” guides this process?

Answer 17

renin-angiotensin-aldosterone axis

Question 18

What triggers the RAA axis to begin?

Answer 18

your kidneys sense that they have decreased perfusion/BP

Question 19

what happens once your kidneys sense decreased perfusion/BP?

Answer 19

kidneys release renin

Question 20

what does renin do?

Answer 20

converts the enzyme angiotensinogen to angiotenin I

Question 21

What then happens to angiotensin I?

Answer 21

the enzyme ACE converts angiotensin I into angiotensin II

Question 22

What does angiotenin II do? (2 things)

Answer 22

1. vasoconstricts (increases resistance/BP)
2. stimulates release of aldosterone from adrenal glands

Question 23

what does aldosterone do?

Answer 23

increases the reabsoption of Na and H20 into the body

Question 24

what do long-term high levels of aldosterone do to the heart?

Answer 24

remodeling

Question 25

what is class 1 HF?

Answer 25

no limitations no symptoms

Question 26

what is class 2 HF?

Answer 26

can do ADLs get symptoms on exertion

Question 27

What is class 3 HF?

Answer 27

increasing limitations with physical activity doing ADLs cause symptoms

Question 28

What is class 4 HF?

Answer 28

getting symptoms at rest or with minimal activity

Question 29

What are the 3 symptoms of HF that are associated with breathing?

Answer 29

dyspnea (on exertion, then with rest) orthopnea paroxysmal nocturnal dyspnea

Question 30

what patho causes dyspnea?

Answer 30

increased venous pressure

Question 31

what patho causes orthopnea?

Answer 31

redistribution of excess fluid to the lungs while supine

Question 32

What is another sx caused by Na and water retention?

Answer 32

unexplained weight gain

Question 33

what patho causes these symptoms: fatigue, weakness, abdominal discomfort?

Answer 33

decreased CO to muscles, GI system

Question 34

Why would a person also get cerebral symptoms with HF (like memory loss)?

Answer 34

decreased perfusion to the brain

Question 35

There are legit so many things for PE so i'm just going to touch on a few. What will you hear when listening to the lungs?

Answer 35

inspiratory crackles starting at bases and moving upward

Question 36

what will you hear when listening to the heart?

Answer 36

S3 gallop

Question 37

what does an S3 gallop sound like?

Answer 37

after S2 (during diastole), a low-pitched thud

Question 38

what causes an S3 gallop?

Answer 38

as blood hits the stiff wall, it rapidly decelerates this hitting and deceleration makes a "thud" sound.

Question 39

On PE you see a + hepatojugular reflux. what is this?

Answer 39

you push on the liver, and see the jugular vein pop out because of all the fluid

Question 40

overall physically, what will this person look like?

Answer 40

cachexic

Question 41

What 2 signs on CXR are somewhat unique to HF?

Answer 41

increased upper lung markings Kerley B lines

Question 42

What is the best diagnostic test for HF?

Answer 42

echo/doppler

Question 43

On ECG, what is it super important that you assess?

Answer 43

**ejection fraction**

Question 44

what does ECG look like for systolic and diastolic failure?

Answer 44

**systolic**: low EF, thin ventricle walls, dilated LV **diastolic**: high EF, thick ventricle walls, small LV

Question 45

You could also get a BNP level. What's the deal with that?

Answer 45

it's released by the ventricles when the heart is acutely stressed

Question 46

How about treatment?

Answer 46

in the next deck :))))))