Heart Failure

Question 1

Describe heart failure

Answer 1

Heart failure occurs when CO2 is inadequate to provide the oxygen needed for the body. Therefore, heart loses its ability to pump blood throughout the body.

Question 2

What are the features of heart failure?

Answer 2

1) Typical Symptoms
2) Typical signs
3) objective evidence of a structural or functional abnormality of the heart at rest.

Question 3

Describe typical symptoms

Answer 3

breathlessness at rest or on exercise, fatigue, tiredness, ankle swelling

Question 4

What are the typical signs?

Answer 4

Tachycardia, tachypnea, pulmonary rales, pleural effusion, raised jugular venous pressure, peripheral edema, hepatomegaly

Question 5

What are the objective evidences of structural or functional abnormality at rest?

Answer 5

Cardiomegaly, third heart sound, cardiac murmurs, abnormality on echocardiogram, raised natriuretic peptide concentration.

Question 6

Causes of heart failure

Answer 6

….

Question 7

Graph explaining the pathway of heart failure. describe some key points from there

Question 8

Describe the pathophysiology of the heart failure

Answer 8

mention hemodynamic alterations
neuro hormonal stimulation
inflammation

Question 9

what is ejection fraction

Answer 9

amount of blood pumped out of the ventricle (systoles, ventricles contracting)
divided by
total amount of blood in ventricle (diastole, ventricles relaxing)

Question 10

What is preload and afterload?

Answer 10

preload: is the stretch, it is the olume of blood received by the heart
afterload: Is the pressure or resistance the heart has to overcome to eject blood. Therefore its the squeeze.

Question 11

Hemodynamics of normal heart at rest and during exercise, tell me about 3 zones

Answer 11

1) low pressure zone
2) transition zone
3) high pressure zone (3-5L/m)

Question 12

Hemodynamics of normal heart during exercise:

Answer 12

15-20L/min in the high pressure zone

Question 13

what is the difference between hemodynamics of the heart with moderate heart failure vs healthy heart?

Question 14

Explain some compensatiton systems

Answer 14

Sympathetic nervous system ( heart rate elevation and vasoconstriction)
Renin- antiotensin system (vasoconstruction, Fluid retention) vasoconstruction causes less o2 going to the tissues
Aldosterone = also causes fluid
Angiotensin causes adrenals to produce aldosterone
Aldosterone causes renal retention of fluid. (Normally under dehydration to maintain cardiac output.)

Question 15

Why is edema caused in heart failure

Answer 15

Due to renal process, the condition that usually occurs under dehydration is ocuring when cardiac output is insufficient. Therefore the fluid thats unable to circulate causes edema

Question 16

Solution to compensation mechanism:

Answer 16

We want to remove the excess input fluid by using diurrtics or venous vasodilators or arterial vasodilution (by increasing.cardiac output)

Question 17

Describe hypovolemia

Answer 17

Hypovolemia occurs when you dont have enough fluid volume circulating in your body

Question 18

What is cardio renal syndrome. What type of mechanism does it have

Question 19

What are heart failure symptoms? (Highlight important ones)

Question 20

Symptoms and signs for congestion for left and right atrium

Answer 20

For Right Atrium:

Neck veins
Pleural effusion
Hepatomegaly
Swollen feet, ankles, legs

For Left Atrium

Shortness of breath durşng exercise
Caugh, orthopnea
Paroxysmal nocturnal dyspnea
Crepirations at auscultation

Question 21

Symptoms and signs for low cardiac output

Answer 21

Poor exercise tolerance
Fatigue
Orthostatic hypotension
Cold extremities
Anlrexia — cachexia
Concentration problems

Question 22

What are the types and patterns of heart failure?

Answer 22

Types :
Left sided vs right sided heart failure
Systolic vs diastolic heart failure

Patterns:
Acute—chronic—transient

Question 23

Describe
Acute
Chronic
Transient
Heart failures

Answer 23

Acute means = new/recent onset. 1st presentation(in left ventricule leads acute dyspnoe = difficulty breathing)
Transient : cardiomyopathy due to
Myocardial infarction with revascularization
Myocarditis
Peripartum
Takotsubo(broken heart syndrome)
Chronic = progressive
Chronic stable vs chronic with exacerbation

Question 24

Compare right and left sided heart failure and present symptoms

Question 25

Systolic vs diastolic heart failure

Answer 25

Ef<35/40% in systolic
Ef almost 60% in normal heart
Ef> 40/50% but the amount of ejected blood may be lower than normal

Question 26

Exarcebation in heart failure (alevlenme)

Answer 26

Intercurrent disease: infection, bleeding
Disease progression: ischemia, infarct, atrial fibrillation…
Diet errors
Poor treatment compliance
NSAID, steroids

Question 27

Talk about disease pattern graphs and severity of HF.

Question 28

Explain the Importance of anamnesis in diagnosis

Answer 28

Stage A
Stage B
—class 1
Stage C
—class 2
—class 3
•class3a
•class3b
—class4
Stage D
—class r

Question 29

Which objective findings are presented in heart failure?

Answer 29

Natriuretic peptides
Echocardiogram
Chest x ray
Cardiac magnetic resonance
Right heart catheterization
Coronary angiogram
Biopsies