heart failure

Question 1

what is heart failure defined as

Answer 1

clinical syndrome = symptoms that accompanied by abnormality = reduced cardiac output/inc intracardiac pressure

Question 2

what are the typical symptoms of heart failure

Answer 2

breathlessness, orthopnoea, nocturnal dyspnoea, reduced exercise tolerance, fatigue, ankle swelling

Question 3

what are the less typical symptoms of heart failure

Answer 3

noctunral cough, wheezing, bloating, dec appetite, confusion, d epression, palpitations

Question 4

what are the 2 types of heart failure

Answer 4

with reduced ejection fraction

or with preserved ejection fraction (+elevated natriuretic peptides + structural heart disease/diastolic dysfunction)

Question 5

what is ejection fraction

Answer 5

measure of systolic cardiac function
stroke V/end diastolic V x 100
nomral values = 60-70%

Question 6

what are the differences between hefref and hefpef

Answer 6

similar stroke volume but for hefpef the diastolic volume is smaller, therefore the percentage is higher

Question 7

how does ischaemic heart failure related to hefref

Answer 7

relationshp between atrial pressure and cardiac output is shifted downward and to the right
inc RA pressure bc congestion in venous circulation
for givn RA, ventricular output is significantly compromised

Question 8

how do we compensate for acute failure

Answer 8

symp stim = baroreflex, low-pressure receptors, chemoreceptors sensitive to ischaemia
riases HR and contractility in preserved myocardium

Question 9

what is the first stage of chronic heart failure

Answer 9

renal fluid retention:
low cardiac output and arterial pressure dec urinary output to preserve BV, inc venous return
- moderate fluid retention can be harmodynamically advantageous
- excess fluid retention (bc low cardiac output + ap) = highly disadvantageous

Question 10

what is the second stage of chronic heart failure

Answer 10

myocardial recovery:
revascularisation therapy + development collateral circulation = rstore o2 blood flow
moderately damaged hearts, myocardial recovery can occur

Question 11

describe typical ventricular remodelling post MI

Answer 11

LV remodelling = progressived LV dilation
firbrotic repair of necrotic region = scar + wall thinning
hypertrophic myocyte elongation in non-infarcted zone
= progressive loss of ventricular performance
exaggerated via neurohumoral mechanisms act during HF
hypertrophic compensation in infarcted zone

Question 12

pulmonary congestion is caused by

Answer 12

damage to LHS heart => reduced left side output = right side congestion + pulmonary oedema => reduced oxygen perfusion

Question 13

what are the mechanisms for long term fluid retention

Answer 13

• decreased glom filtration rate
• RAAS act
• aldosterone secretion = salt reabsorption
• sympathetic acti

Question 14

how do you manage a patient with heart afailure

Answer 14

ACE = inhib RAAS = reduce fluid retention = low ap, slow ventricular remodeling
beta-blocker= lower HR -> reduce O2
mr antagonist = reduce secretion and effects of aldosterone on fluid retention and ventricular remodelling

Question 15

types of hefref that are not ishchaemic

Answer 15

inherited heart disease = dilated cardiomyopathy, hypetrophic
tachyarrythmias’s = atrial fibrilation + ventricular arrhytmias
infiltrative diseases = amyloidosis, sarcoiosis
valvular disease

Question 16

what are the main effects of hefpef

Answer 16

abnormal haemodynamics bc myocardial stiffness, inc LV filling pressure w/diastolic abnormalities
low SV, coupled with chronotropic incompetence = impaired cardiac output

Question 17

what are the risk factors hefpef

Answer 17

hypertensive remodelling
ventrocular and vascular stiffening 
sedentary lifestyle 
obesirt and metabolic stress 
ageing

Question 18

pathophysiological changes of hefpef

Answer 18

concentric hypetrophy of LV
in cardiomyocyte passive stiffness
excessive collagen deposition 
reduced ca uptake 
endothelial dysfunction 
reduced NO bioavailability 
coronary microvascular abnormalities 
aterial stiffening

Question 19

what are the treatments of hefpef

Answer 19

targets risk factors
weight loss
raas/mineralocorticoid antagonists