Heart Failure

Question 1

Heart failure

Answer 1

Inability of heart to pump blood to meet the body’s demands

Question 2

Caused by impairments to…

Answer 2

The hearts ability receive blood and eject blood

Question 3

2 main factors that affect CO

Answer 3

Preload and afterload

Question 4

Preload

Answer 4

The degree to which heart fibers are stretched just prior to contraction
- the more stretch, the more contraction

Question 5

Afterload

Answer 5

The degree of pressure in the aorta that must be overcome for blood to be ejected from the left ventricle
-hypertension effects afterload

Question 6

Cardiac remodeling

Answer 6

Increased workload overtime leads to heart weakness

Question 7

Left sided HF

Answer 7

Congestive heart failure

Ventricle cant eject all the blood in it… accumulates in the ventricle… the walls thicken and change size, shape, and structure of the heart cells… heart cells die and scar tissue forms making the wall stiff

If enough blood backs up, it goes into the lungs causing SOB, coughs, audible crackles, wheezes, and exercise intolerance

Question 8

Right sided HF

Answer 8

Blood backs up into veins resulting in peripheral edema and engorgement of organs such as liver

Question 9

Symptoms of heart failure

Answer 9

Dyspnea
Fatigue
Pulmonary congestion
Peripheral edema
Orthopnea (feels like suffocating)

Question 10

Identifying HF

Answer 10

B-type Natriuretic Peptide (BNP)

Question 11

Goals of hf therapy

Answer 11

Reduce preload
Reduce blood pressure
Inhibit RAAS and vasoconstriction from SNS

Question 12

Drugs used to treat hf

Answer 12

ACE Inhibitors
Diuretics
Beta-blockers
Cardiac Glycosides
Vasodilators
Phoshpodiesterase Inhibitor

Question 13

ACE inhibitor

Answer 13

“Pril”
1st line for HF over digoxin

Lower peripheral resistance (Dec BP)
Inhibit aldosterone secretion (Dec BVol)
Dilates veins (Dec pulmonary congestion and reduces peripheral edema)

End result is to decrease in afterload and increase CO

Question 14

Diuretics

Answer 14

Use if: Stage C-vol overload, edema, pulmonary congestion

Dec BVol
Only used when there are signs of fluid retention
Loop diuretics most commons
Used with ACE or ARB

Question 15

Beta Blockers

Answer 15

“Olol”

Standard treatment for patients with HF
HF activates SNS

Blocks SNS (Dec HR and BP)
Can improve size, shape, and function

Combined with ACE or ARB

Question 16

Cardiac Glycosides

Answer 16

Used for 2000 years
From purple and white foxglove plants

Slows HR and Inc the force (+ into tropic effect)

Advanced stages of HF
Narrow therapeutic index (monitor digoxin levels)

Question 17

Phosphodiesterase Inhibitors

Answer 17

Used for acute HF when necessary
ONLY for emergencies to avoid organ failure or death

Block the enzyme phosphodiesterase in cardiac and smooth muscle
Inc cAMP and cGMP which results in:
- + inotropic effect
- vasodilation
- short half life
- high risk for toxicity