Heart Failure

Question 1

What is Heart Failure?

Answer 1

Insufficient oxygen delivery due to imbalance between the requirements and the needs

Question 2

With whom is heart failure more common?

Answer 2

In elders: >65 y/o

Question 3

What is ejection fraction? How is it measured?

Answer 3

Pressure needed to eject oxygenated blood
It is measured as the amount of blood that your heart pumps each time it beats: stroke volume

Question 4

Classification of ejection fraction

Answer 4

• HFrEF (reduced EF < 40%)
• HFmEF (mildly impaired EF 40-49%)
• HFpEF (preserved EF ≥ 50%)

Question 5

Etiology of heart failure? (7)

Answer 5

Endocardial, valvular heart, pericarial and myocardial disease, high output states, volume overload and arrythmia

Question 6

Etiology of high output states (3)

Answer 6

Anaemia
Sepsis
Thryotoxicosis

Question 7

Etiology of volume overload

Answer 7

Renal failure

Question 8

Etiology of myocardial disease (3)

Answer 8

Coronary - there is ischemia and some parts of the heart die
Hypertension - more force, less volume
Cardiomyopathy

Question 9

Pathophysiology of heart failure and causes (4)

Answer 9

Ventricular remodeling
1. Electrical instability
2. ejection Fraction is reduced
3. neurohormonal imbalance
4. injury to myocytes due to myocardial infraction or other causes

Question 10

What is the cardiac output

Answer 10

Stroke volume x Heart Rate
= 70 ml/beat x 70 bpm = 4900 ml/min ≈ 5 lt/min

Question 11

Systolic Heart failure

Answer 11

Impaired contraction
Demographics: any
Cause: coronary artery disease
Less blood pumped, weak muscle

Question 12

Diastolic Heart Failure

Answer 12

Impaired filling
Demographics: >60
Cause: hypertension
Less blood filling, stiff heart

Question 13

Which is the most common Heart Failure

Answer 13

Left-sided heart failure systolic which accumulates bloods on the atrium and returns to the lungs

Question 14

What is pulmonary edema

Answer 14

Right side also pumps and the lungs get filled with blood in the interstitial space

Question 15

Breathelessness, Orthopnea, Paroxysmal nocturnal dyspnea, Reduced excercise tolerance, Fatigue, Ankle swelling are..

Answer 15

Typical symptoms of heart failure

Question 16

Nocturnal cough, Wheezing, Bloated feeling, Loss of apetite, Palpitations, Syncope

Answer 16

Atypical symptoms of heart failure

Question 17

Specific signs of heart failure

Answer 17

Elevated jugular venous, Hepatojugular reflux, Third heart sound, Laterally displaced apical impulse

Question 18

NIHA Heart Failure classification

Answer 18

1) Great effort - climbing stairs
2) Medium - walking 100 m or a block
3) Small - standing up or dressing
4) Rest - doing nothing and they can´t breathe

Question 19

AHA Heart failure classification

Answer 19

A. At high risk but no structural or functional abnormality
B. Developed structural, without signs or symptoms
C. Symptomatic associated with structural heart disease
D. Advanced structural and marked symptoms at rest, despite maximal medical therapy

Question 20

Studies in Heart Failure

Answer 20

X Ray
Electrocardiogram - to see ischemia or arrythmias
*Echocardiogram - confirms heart failures because it checks ejection fraction

Question 21

Treatment for Heart Hailure

Answer 21

• Ace inhibitors: to stop high blood pressure, protects the kidneys and stops remodeling going further
• Beta blockers: to regulate rythm
• Diuretics: to get rid of water in lungs it deactivares RAA

Question 22

Aetiology of Heart Falure (CHAMP)

Answer 22

C - acute Coronary syndrome
H - hypertension emergency
A - arrythmia
M - acute mechanical cause
P - pulmonary embolism