Heart Failure

Question 1

The Heart Failure Society of America (HFSA) describes two broad categories:

Answer 1

1. HF with reduced EF
2. HF with preserved EF

Question 2

Systolic HF, the EF is usually _____ %

Answer 2

35

Question 3

Diastolic EF, the EF may be _____

Answer 3

normal

Question 4

The term CHF (congestive heart failure) is not preferred unless the patient has symptoms of decompensation.

T or F ?

Answer 4

T

Question 5

_______ occurs when CO fails to meet the body’s metabolic needs:

• heart does not pump effectively
• systolic/diastolic dysfunction may occur
• fluid vol overload
• requires immediate medical attention

Answer 5

ADHF (acute decompensated HF)

Question 6

Echo findings of HF includes:

Answer 6

• decreased RV/LV function
• increased RV/LV size
• may detect underlying cause
• regurgitation

Question 7

Left sided HF is result of:

Answer 7

• damage to LV myocardium
• pulmonary congestion
• increased pulmonary pressure
• decreased renal function
• edema
• weight gain
• fatigue
• muscle weakness
• confusion
• CP due to MI./ischemia

Question 8

Right sided HF is result of:

Answer 8

• (typically follows) left sided HF due to increased pulmonary pressure
• venous congestion and dependent edema

Question 9

HF causes:

Answer 9

• decreased myocardial contractility - due to CAD, myocarditis, cardiomyopathy, collagen vascular disease, drugs
• increased myocardial workload - due to systemic hypertension, PH, valvular disease, ASD, VSD, cardiomyopathy
• filling disorders that interfere with the heart’s ability to pump blood effectively and cause a drop in CO i.e. tamponade, constrictive pericarditis, cardiomyopathy
• dysrhythmia i.e AFib, persistent tachycardiac dysrhythmia
• marked bradycardiac dysrhythmia

Question 10

As the heart fails, the body compensates in an attempt to maintain the CO. This compensatory mechanism may delay the development of symptoms, but often causes further damage and worsen the HF.

T or F ?

Answer 10

T

Question 11

What are the 3 primary components to the compensatory mechanism?

Answer 11

1. chronotropic force - increase HR
2. inotropic force - hypertrophy of the heart walls that enables the heart to contract with more force. *This leads to greater myocardial O2 demand leading to further deterioration.
3. ventricular dilatation - with thinning of the heart walls, which initially increase the CO by increasing the preload, but eventually leads to further deterioration

Question 12

What are the complications of HF?

Answer 12

As a result of the heart’s failure to empty the venous system and pump to the atrial system, the following complications may arise:

• increased LV/RV pressure
• elevated systemic/pulmonary pressure
• decreased CO

Question 13

treatment of HF

Answer 13

• medical therapy: beta blocker, diuretic, vasodilator, ACE inhibitor, inotropic drug
• IABP (intra-aortic ballon pump)
• LVAD (LV assist device): saved for patients with end-stage HF and can be used as a bridge to heart transplantation
• heart transplant