Heart/Cardiac Failure Flashcards
Heart failure is a collection of symptoms (syndrome) where the heart is unable to deliver sufficient blood to the body. What is the most common cause of heart failure?
1 - hepatic fibrosis
2 - CKD
3 - IHD (cardiomyopathy)
4 - aortic stenosis
3 - IHD (cardiomyopathy)
Heart failure is due to a cardiomyopathy. Which 2 are the key causes?
1 - LV pumps too much blood
2 - atrium over fill
3 - atrium cannot fill with sufficient blood
4 - ventricles cannot pump sufficient blood
3 - atrium cannot fill with sufficient blood
- associated with diastolic function
4 - ventricles cannot pump sufficient blood
- associated with systolic function
- BOTH cause blood to back up into lungs and fluid builds up
How may new patients are diagnosed with heart failure per year in the UK?
1 - 200
2 - 2000
3 - 20,000
4 - 200,000
4 - 200,000
- this is incidence
What is the mean age at presentation of heart failure?
1 - 50 y/o
2 - 65 y/o
3 - 77 y/o
4 - 85 y/o
3 - 77 y/o
What is the 5-year mortality in patients with heart failure in the UK?
1 - 1%
2 - 5%
3 - 20%
4 - 50%
4 - 50%
- almost like a cancer
- <1 year in advanced heart failure
Left systolic heart failure failure is as a result of which of the following?
1 - LV weakness
2 - LV dilation
3 - dilated cardiomyopathy
4 - all of the above
4 - all of the above
- means any subsequent contractions are weaker
All of the following are causes of left ventricular heart failure. What is by far the most common cause?
1 - IHD (acute MI or chronic ischaemia)
2 - Hypertension
3 - Inherited (autosomal dominant)
4 - Alcohol excess
5 - Post viral
6 - Toxins (eg chemotherapy drugs)
7 - Metabolic (eg hypothyroid, iron overload, thiamine deficiency)
8 - Unknown cause (‘idiopathic’)
1 - IHD (acute MI or chronic ischaemia)
Afterload is the force the heart has to generate to eject blood out of the LV. What is the key determining factor that determines afterload?
1 - SV
2 - HR
3 - SVR
4 - preload
3 - SVR
How do we calculate stroke volume?
1 - SVR / end diastolic volume (EDV)
2 - SVR / end systolic volume (ESV)
3 - EDV - ESV
4 - EDV - ejection fraction
3 - EDV - ESV
To measure LV function we can look at the ejection fraction (EF). Which of the following is the correct formula for this?
1 - EF = HR x SV
2 - EF = (HR / SVR) x 100
3 - EF = (SV / EDV) x 100
4 - EF = (SV / ESV) x 100
SV = stroke volume
HR = heart rate
EDV = end diastolic volume
ESV = end systolic volume
3 - EF = (SV / EDV) x 100
What is a normal ejection fraction?
1 - 20%
2 - 30%
3 - 40%
4 - >50%
4 - >55%
- 40-50% is borderline
- <40% is systolic HF
The frank starling mechanism is useful to understand the relationship between systolic and diastolic function. What does the frank starling mechanism show?
1 - increased atrium filling means more ventricular contraction
2 - increased ventricular stretching results in greater stroke volume
3 - increased ventricular stretching results in reduced preload
4 - reduced ventricular filling increased afterload
2 - increased ventricular stretching results in greater stroke volume
- like a rubber band, the more the stretch the ventricle in diastole = a greater contract force and a larger SV in systole
All of the following occur in systolic left sided heart failure, what is the first common sign of left sided heart failure?
1 - increased LV diastolic pressure
2 - increased end diastolic volume
3 - reduced ejection fraction
4 - increased SV
3 - reduced ejection fraction
- results in reduced SV
- SV = EDV - ESV
- EF = (SV / EDV) x 100
- weak heart so decreased left ventricle contractility
What is the diagnostic cut off for systolic heart failure?
1 - left ventricle ejection fraction <60%
2 - left ventricle ejection fraction <50%
3 - left ventricle ejection fraction <40%
4 - left ventricle ejection fraction <30%
3 - left ventricle ejection fraction <40%
- when ejection fraction drops <40% is when patients present with symptoms
The volume of blood the left ventricle is able to eject is dependent on preload (stretching of the cardiomyocytes) as they fill. If the preload is low, what can this cause?
1 - LV hypertrophy
2 - reduced ejection fraction
3 - increases ejection fraction
4 - insufficient SV
4 - insufficient SV
- essentially less blood being pumped around the body per beat
Heart failure can be subdivided into 3 clinical syndromes. What are these 3 syndromes?
1 - chronic heart failure = peripheral oedema
2 - acute heart failure = pulmonary oedema
3 - cardiogenic shock = low BP (<90mmHg)
In systolic left sided heart failure, stroke volume is decreased due to a weakened left ventricle. More blood is left in the left side of the heart at the end of systole. Which of the following can this then cause?
1 - increased left atrium (LA) pressure
2 - increased pulmonary venous pressure
3 - pulmonary oedema
4 - all of the above
4 - all of the above
- more blood left in LV
- LA requires more pressure to force blood into LV
- venous pressure builds up to overcome pressure in LA
- fluid backs up into the lungs causing pulmonary oedema
If the pressure in the left atrium increases as a response to having to work harder to pump blood into the left ventricle (if not emptying properly), what affect does this have on the left atrium?
1 - tricuspid regurgitation
2 - left atrium hypertrophy
3 - left atrium dilation
4 - atrial flutter
3 - left atrium dilation
In systolic left sided heart failure, stroke volume is decreased due to a weakened LV. LA pressure to force blood into LV, venous pressure increases up to overcome pressure in LA and fluid backs up into the lungs causing pulmonary oedema. Which of the following can this then lead to?
1 - increased pulmonary artery pressure (back to the RV)
2 - increased right atrium pressure
3 - increased right ventricle pressure
4 - peripheral oedema
5 - all of the above
5 - all of the above
- pressure essentially works backwards from the lung to the heart, and eventually increases pressure for blood to return to the heart
If there is a decrease in the contractility of the left ventricle that causes a reduction in cardiac output, what does this activate?
1 - sympathetic activity
2 - RAAS system
3 - Na+ and H2O retention
4 - all of the above
4 - all of the above
- low blood flow to kidneys activates RAAS
- RAAS retains H2O and Na+ to increase BP
- sympathetic activity aims to increase contractility and increase cardiac output
Which of the following are the common symptoms that patient present with in heart failure may present with?
1 - breathlessness on exertion
2 - Orthopnoea (breathlessness lieing down)
3 - Paroxysmal nocturnal dyspnea (PND) (breathlessness sleeping)
4 - Fatigue due to low cardiac output
5 - Leg swelling (oedema) due to change in pressures
6 - cyanosis
7 - cough/wheeze/crackles
8 - all of the above
6 - all of the above
A clinical sign of heart failure is a raised jugular venous pressure. What is this an indicator of?
1 - raised LV pressure
2 - raised LA pressure
3 - raised RV pressure
4 - raised RA pressure
4 - raised RA pressure
- but this can be caused by an increase in pressure in all the other options as well
Which are the most typical clinical signs of oedema that we may see in a patient with heart failure?
1 - ankle
2 - shins
3 - thighs
4 - genitals
5 - trunk
6 - all of the above
6 - all of the above
- depends on the severity of the heart failure
A clinical sign of a patient with heart failure is a pleural effusion. What is this?
1 - fluid collecting in the pericardial sac
2 - fluid collect the diaphragm
3 - fluid collecting in the space between the lungs and chest cavity
4 - all of the above
3 - fluid collecting in the space between the lungs and chest cavity
- pleural = space between lungs and chest cavity
- effusion = collection of fluid
Which of the following are clinical signs that we may be able to identify in a patient with heart failure?
1 - Lung crackles (inspiration, bases)
2 - Low volume pulse, low BP
3 - Tachycardia, increased respiratory rate
4 - Displaced apex beat
5 - Murmur (functional MR)
6 - Liver enlargement (hepatomegaly)
7 - ascites
8 - all of the above
8 - all of the above
- Lung crackles = pulmonary oedema
- Low volume pulse, low BP = poor contractility
- Tachycardia = aim to increase cardiac output
- Displaced apex beat
- Murmur = mitral regurgitation during systole
- Liver enlargement (hepatomegaly) - congested liver due to fluid backed up
- ascites = fluid backs up into portal system
What method is used to stratify the severity of heart failure?
1 - NICE severity score
2 - AHA classification
3 - Fredricks classification
4 - New York Heart Association (NYHA)
4 - New York Heart Association (NYHA)
- class 1 = asymptomatic
- class 2 = mild symptoms (ADLs)
- class 3 = moderate symptoms (exertion)
- class 4 = symptoms at rest
In patients with heart failure, which 3 of the following are simple non invasive assessments can clinicians perform?
1 - JVP assessment
2 - ECG
3 - brain natriuretic peptide (BNP)
4 - lung auscultation
5 - pitting oedema
6 - ascites test
1 - JVP assessment
4 - lung auscultation
5 - pitting oedema
When looking at an ECG in a patient with heart failure, which of the following traits are we likely to see?
1 - Tall complexes (‘LV hypertrophy’)
2 - Broad complexes (‘Left bundle branch block’)
3 - T wave inversion
4 - Tachycardia
5 - all of the above
4 - all of the above
- Tall complexes = LV hypertrophy
- Broad complexes (‘Left bundle branch block’)
- T wave inversion
- Tachycardia = aims to increased cardiac output