Heart Failure

Question 1

Heart failure as a result of excessive haemodynamic burden is another low cardiac output state, what does it involve?

Answer 1

this time involving a relative (not an absolute) failure of contractility to pump sufficient blood to perfuse the tissues in the face of a disruption or obstruction to output

Question 2

Name the 4 topics of heart failure

Answer 2

Systolic dysfunction

Diastolic dysfunction

Excessive haemodynamic burden

Unrealistic peripheral demand for tissue perfusion

Question 3

What is cardiac output?

Answer 3

The product of heart rate (HR) and stroke volume (SV) (i.e., the volume of blood pumped per beat), which is itself dependent on force of contraction. So in mathematical terms, CO=HR*SV

Question 4

what is the likely cause of “Heart failure as a result of excessive haemodynamic burden”?

Answer 4

This can be related to abnormal blood movement or flow (as in valvular disease or heart problems such as septal defects present at birth) or abnormally high blood pressure.

Question 5

in “Heart failure as a result of excessive haemodynamic burden”

what causes stroke volume and corresponding cardiac output (i.e. leads to left heart failure).

Answer 5

Arterial hypertension provides an increased burden (or afterload) related to increased total peripheral (or systemic vascular) resistance on the left ventricle, which limits how much blood can be pumped into the aorta against this higher pressure
– and which in turn reduces stroke volume and corresponding cardiac output (i.e. leads to left heart failure).

Question 6

what account for the majority of heart failure disease cases in the western world?

Answer 6

arterial hypertension along with ischaemic heart disease-related systolic dysfunction

Question 7

What is the Frank Starling mechanism?

Answer 7

Cardiac stretch (related to preload and caused by blood returning (venous return) to the ventricles during diastole, i.e. end diastolic volume) is related to the force of contraction and thereby stroke volume,

Question 8

what is heart failure due to “Unrealistic peripheral demand for cardiac output​” related to?

Answer 8

decreased oxygen-carrying capacity of blood, e.g.​severe anaemia​

excessive metabolic demand for tissue perfusion, e.g. thyrotoxicosis​

maintenance of blood pressure in face of severe hypotension, e.g.​
severe infection/sepsis, anaphylaxis (involves peripheral vasodilation/fall in total peripheral resistance)​

and
hypovolaemic circulatory shock​

Question 9

How is Systolic dysfunction defined?

Answer 9

Absolute failure of contractility

Low cardiac output state

Question 10

How is Diastolic dysfunction defined?

Answer 10

Ventricular diastolic filling failure

Low cardiac output state

Increased ventricular stiffness (reduced compliance)

Question 11

what leads to a state of right heart failure secondary to lung disease known as cor pulmonale.?

Answer 11

pulmonary hypertension has the same effect on stroke volume involving the right ventricle, leading to a state of right heart failure secondary to lung disease known as cor pulmonale.​

Question 12

these terms:

Relative failure of contractility​ and Low cardiac output state​.

are synonymous to what?

Answer 12

Excessive haemodynamic burden

Question 13

which diseases are related to “heart failure due to Excessive haemodynamic burden”

Answer 13

valvular disease ​

congenital heart defects​

increased total peripheral resistance​

arterial hypertension (= left heart failure)​

increased pulmonary resistance (associated with lung disease)​

pulmonary hypertension (= right heart failure “cor pulmonale”)​

​

​

Question 14

what is heart failure due to “Unrealistic peripheral demand for cardiac output​” related to?

Answer 14

decreased oxygen-carrying capacity of blood, e.g.​severe anaemia​

excessive metabolic demand for tissue perfusion, e.g. thyrotoxicosis​

maintenance of blood pressure in face of severe hypotension, e.g.​
severe infection/sepsis, anaphylaxis (involves peripheral vasodilation/fall in total peripheral resistance)​

and
hypovolaemic circulatory shock​

Question 15

explain what happens during heart failure due to “Unrealistic peripheral demand for cardiac output​”

Answer 15

the heart fails to either maintain an unreasonable required level of tissue perfusion

or sustain sufficient arterial blood pressure for tissue perfusion in the face of severe hypotension, associated with e.g. septic or anaphylactic shock and other types of circulatory failure, such as hypovolaemic shock.

Question 16

in heart failure due to “Unrealistic peripheral demand for cardiac output​”

why does the heart fail to maintain an unreasonable required level of tissue perfusion?

Answer 16

that is due to limited blood oxygen-carrying capacity as in severe anaemia or excessive metabolic demand as in the hypermetabolic state of thyrotoxicosis; ​

Question 17

what is blood pressure a result of?

Answer 17

blood pressure (BP) is the product of cardiac output (CO) and total peripheral resistance (TPR), i.e. BP=CO*TPR.​

Question 18

__________ causes causes a relative failure of cardiac contractility, as the heart (although still failing) is functioning normally and responding to what is an impossible challenge

Answer 18

unrealistic demand for cardiac output

Question 19

what are the main symptoms of heart failure?

Answer 19

Breathlessness (during activity or at rest; may be worse when lying down, e.g. at night)​

Fatigue (tired most of the time) and exercise intolerance​

Swollen ankles (due to oedema)​

Question 20

what are the less common symptoms of heart failure?

Answer 20

Persistent cough (worse at night)​

Wheezing​

Bloating around abdomen (peritoneal fluid accumulation or ascites)​

Loss of appetite​

Weight change​

Confusion​

Dizziness and fainting​

Tachycardia​

Pounding, fluttering or irregular heart beat (palpitations)​

Question 21

_________ are related to pulmonary congestion, fluid accumulation/oedema and pleural effusion stemming from a rise in pulmonary venous pressure (linked to failure of the left heart). Swollen ankles (as well as feet and legs) reflect peripheral oedema owing to fluid retention, venous circulatory congestion and a rise in central venous pressure (linked to failure of the right heart).

Answer 21

Respiratory problems

Question 22

___________ is the result of a more general, compensatory sympathetic autonomic nervous system discharge (also linked with cold, pallid skin in respect of peripheral vasoconstriction), aimed at raising cardiac output in order to support blood pressure for tissue perfusion.

Answer 22

Tachycardia

Question 23

Feeling tired most of the time reflects ____________

Answer 23

a lack of blood supply to working (skeletal) muscle

Question 24

__________ could potentially lead to multiple organ failure

Answer 24

general lack of tissue perfusion