Heart Failure

Question 1

Pathologic changes that lead to heart failure

Answer 1

increased fluid volume/FVO, impaired ventricular filling, decreased ventricular contractile function

Question 2

Etiology of heart failure

Answer 2

Ischemic heart disease, chronic hypertension, chronic pulmonary disease, cardiomyopathies, dysrhythmias, heart valve abnormalities

Question 3

How does ischemic heart disease cause heart failure

Answer 3

lack of sufficient coronary circulation causes repeated ischemia or infarction to the myocardium, decreasing the contractions of the ventricles

Question 4

How does chronic hypertension cause heart failure

Answer 4

LVH occurs predisposing the left ventricle to ischemic injury and inadequate perfusion, enlarging the cardiac muscle, more workload and weakened ventricles

Question 5

How does restrictive cardiomyopathy cause heart failure

Answer 5

the ventricle is impaired from filling to full capactiy

Question 6

How does ischemic cardiomyopathy cause heart failure

Answer 6

fibrous and scarring of the heart muscle cause by coronary insufficiency and MI

Question 7

How does hypertrophic cardiomyopathy cause heart failure

Answer 7

the left ventricle is enlarged and the hypertrophy causes stiffness and obstruction of blood during systole cause by genetic predisposition

Question 8

How do tachydysrhythmias cause heart failure

Answer 8

reduce the time available for ventricular filling

Question 9

How do bradydysrhythmias cause heart failure

Answer 9

slow the heart rate enough to minimize CO

Question 10

How do atrial dysrhythmias cause heart failure

Answer 10

diminish the volume emptied into the ventricle, decreasing SV and CO

Question 11

How does mitral regurgitation cause heart failure

Answer 11

the mitral valve does not close completely during systole –> back-up of fluid into the atrium –> backward pressure in the pulmonary veins –> increased pulmonary capillary hydrostatic pressure
–> fluid leakage into the pulmonary interstitium

Question 12

How does aortic stenosis cause heart failure

Answer 12

calcification of the aortic valve with aging, narrowing the valve and impedes ejection of blood flow from the left ventricle causing LVH

Question 13

How do endocarditis and myocarditis cause heart failure

Answer 13

infection causes biochemical and structural changes to the heart. Leads to deterioration of contractile strength of ventricular muscle

Question 14

How does a pulmonary embolism cause heart failure

Answer 14

raises pressure creating a backwards resistance into the right ventricle, weakening the muscle causing RVF

Question 15

Acute heart failure

Answer 15

occurs from a massive MI that causes ventricular injury leading to cardiogenic shock from the inability to maintain blood pressure and perfusion to the body

Question 16

Systolic dysfunction

Answer 16

the weakened ventricle has difficulty ejecting blood out of the chamber, or poor forward pumping action which causes reduced SV/CO

Question 17

Diastolic dysfunction

Answer 17

the ventricle has difficulty relaxing and cannot fill, pumping out insufficient volume of blood for the body

Question 18

High-output failure

Answer 18

the heart cannot pump blood to the tissues

Question 19

Low-output failure

Answer 19

not enough blood returns to the heart

Question 20

Diagnostic criteria for heart failure

Answer 20

need one major and two minor criteria, observe clinical manifestations, history, and lab finding

Question 21

Major s/s of heart failure

Answer 21

PND, JVD, pulmonary crackles, cardiomegaly, S3 sound, increased CVP, hepatojuglar reflux

Question 22

Minor s/s of heart failure

Answer 22

bilateral edema, DOE, hepatomegaly, pleural effusion, tachycardia, reduced pulmonary capacity

Question 23

What lab and diagnostic studies are done

Answer 23

BNP levels, serum electrolyte levels, chest x-ray, ECG, echocardiogram

Question 24

BNP

Answer 24

increased secretion due to stretching of the ventricle with increased fluid volume, >500 is indicative of heart failure

Question 25

Serum electrolytes

Answer 25

excess fluid volume causes hyponatremia/kalemia, constant cycling of RAAS chaanges potassium excreting from kidneys, hypokalemia increases dysrhythmia risk

Question 26

Chest x-ray

Answer 26

shows cardiac shadow, cardiomegaly, vascular congestion, kerley A/B lines

Question 27

What do kerley A/B lines indicate

Answer 27

engorged blood vessels of the lungs –> left sided HF

Question 28

ECG

Answer 28

demonstrated various abnormalities

Question 29

Echocardiogram

Answer 29

shows activity and structures of the heart

Question 30

Treatment of heart failure

Answer 30

diuretics, synthetic natriuretics, vasodilators, ACE inhibitors, beta-adrenergic blockers, inotropic agents, LVAD, intra-aortic assist device, cardiac resynchronization therapy

Question 31

Diuretics

Answer 31

enhance water loss

Question 32

Synthetic natriuretics

Answer 32

synthetic form of BNP that acts to increase diuresis at renal vasculature

Question 33

Vasodilators

Answer 33

nitrates are both arterial and venous vasodilators that enhance coronary circulation and decrease the heart’s workload

Question 34

ACE inhibitors

Answer 34

inhibit vasoconstriction and stimulation of aldosterone, decreases resistance against LV, lower blood volume and and ease workload of the heart

Question 35

Beta-adrenergic blockers

Answer 35

inhibit effects of SNS, reduces strain on heart

Question 36

Inotropic agents

Answer 36

increase the contractile force of the heart muscle

Question 37

Digitalis

Answer 37

inotropic agent that increases the force and rate of the heart, slowing conduction through AV node, measure apical pulse for 1 minute, monitor potassium

Question 38

Intra-aortic balloon assist device

Answer 38

increase aortic pressure and blood flow

Question 39

CRT

Answer 39

specialized pace maker to optimize pumping by coordinating impulse