Heart failure

Question 1

Cardiomyopathy and causes

Answer 1

• disease of the myocardium
• often idiopathic, can be caused by HTN, ischemia, inherited disease, infx, toxins, myocarditis, auto-immune condition
• leads to HF
  ***Pump problem

Question 2

Dilated cardiomyopathy

Answer 2

• ischemic prob, bowel disease, post/peripartum, drugs, infx, genetic
• leads to heart fail with dec EF
• expanded L vent

Question 3

Hypertrophic cardiomyopathy

Answer 3

• huge left vent muscle; EF dec with time
• r/t HTN
• high risk of arrythmias

Question 4

Restrictive cardiomyopathy

Answer 4

• least common
• ventricles resistant to filling (hardens), rigid and stiff
• R side heart fail, systemic congestion
• r/t amyloid disease

Question 5

Heart failure

Answer 5

chronic progressive condition where the heart muscle can’t pump enough blood to meet the body’s needs for blood and oxy
- dec CO, dec myo contractility, inc pre and afterload

Question 6

preload

Answer 6

amount of fluid vol in the L vent before it squeezes

Question 7

afterload

Answer 7

pressure the heart has to squeeze against when it contracts (high BP, high afterload)

Question 8

myocardial contractility

Answer 8

How efficiently the pump works

Question 9

HF patho

Answer 9

• volume overload from heart not pumping well
• impaired ventricular filling (worse diastole)
• weak ventricular muscle
• dec ventricular contractility function - squeeze not as effective

Question 10

Causes of HF

Answer 10

• repeated ischemic episodes of unstable angina and MI (papillary muscle rupture)
• chronic HTN, COPD (altered pump pressure alters R vent)
• dysrhythmias that dec CO and perfusion
• valve disease
• PE (RVF)

Question 11

Risk fx for HF

Answer 11

HTN, DM, MI, Black/AfAm, genetics, 65+, smoking and sedetary, obesity, severe anemia, congenital heart defect, viruses, alc/drug abuse esp cocaine and crack, kidney prob (inc BF, HTN, accum nitrogenous waste)

Question 12

Left side heart HF

Answer 12

• blood builds up in pulmonary circulation
• pulmonary edema, crackles, wheezes, frothy sputum (bloody too), orthopnea, paroxysmal nocturnal dyspnea (PND), tripod position
• HTN often

Question 13

R side heart failure

Answer 13

• blood builds up in systemic circ
• often bc severe COPD with cor pulmonale
• congested R chambers and R vent hypertrophy b/c pulmonary HTN from vasoconstriction pushes back against the blodd
• backflow into vena cava dec to lungs
• JVD, dependent edema, wt gain, hepatosplenomegaly
• pulm HTN

Question 14

Normal EF

Answer 14

55-65%

Question 15

HFrEF aka systolic HF

Answer 15

• EF under 40%
• impaired contractility, inc afterload, inc cardiomyopathy, mechanical problems
• L vent loses squeezing power (dec SV and CO)
• L vent fail, blood b/u, fluid accum

Question 16

HFpEF aka diastolic HF

Answer 16

• vents can’t relax and fill with diastole
• HTN main cause (also obese, fem, old at risk)
• L vent still, noncompliant, high filling pressure (dec SV and CO)
• dec CO–fluid congestion
• EF norm or moderate (40-44%)

Question 17

Chronic HF

Answer 17

• episodes of decomp HF with new or worsening s/s

Question 18

What occurs with chronic HF?

Answer 18

Ventricular remodeling

Question 19

Ventricular remodeling

Answer 19

• weak heart muscle secreted angio II, aldosterone, catecholamines, ILGF, growth hor, and TNF-alpha
• provoke genetic change of cells that cause apoptosis, hypertrophy of cardiomyocytes, collagen deposits, and myocardial fibrosis

Question 20

When is S3 gallop common?

Answer 20

during rapid fill of ventricle in early part of diastole
- inc pressure w/i ventricle
- high ventricle diastolic end vol
- abnormal–HF in ppl over 40

Question 21

Best tx for HF

Answer 21

dec causes