Heart Failure

Question 0

Left ventricular HF: presentation

Answer 0

• most commonly presents with dyspnea
• commonly orthopnia, nocturia
• PND (paroxysmal nocturnal dyspnea)
• fatigue
• acute pulmonary edema
• hemoptysis (pulmonary congestion)
• Cheyne-stokes respiration: thats bad

Question 1

NYHA classification

Answer 1

I. No symptoms during routine activity
II. Symptomatic during routine in activity
III. Comfortable at rest, symptoms with less than routine
IV. Symptomatic with any activity and often rest

Question 2

RSHF: presentation and etiology

Answer 2

• systemic venous congestion -> peripheral edema
• due to pulmonary HTN
• failure of shared myocytes in the septum
• often includes GI (anorexia, NVD, ascities)
• Cyanosis (typically absent in LVHF)

Question 3

High vs. Low output Heart failure

Answer 3

• in high output: HR remains brisk, skin and extremities are warm
  > due to increased metabolic demands
  > anemia, hyperthyroidism, beriberi, AV fistula, pagets
• in low output: classic HF
  > causes HTN, MI, cardiomyopathy, valve disease, pericardial disease

Question 4

Systolic dysfunction

Answer 4

• mostly eccentric (dilated)

- decrease in contractility -> decreased CO

Question 5

Diastolic failure

Answer 5

• pulmonary/venous congestion
  > impaired venous return
  > chamber stiffness, dilation/hypertrophy
• may have normal LV ejection

Question 6

Types of cardiomyopathy and causes

Answer 6

• dilated: congestive, infection, toxin (EtOH, doxorubicin)
• hypertrophic: concentric LV hypertrophy
• infiltrative: amyloid, sarcoidosis, hemochromatosis

Question 7

Eccentric vs concentric hypertrophy

Answer 7

• concentric: in parallel, diastolic dysfunction, S4

- eccentric: in series, systolic dysfunction, S3

Question 8

Progression of HF, Days: circulatory and cardiac issues

Answer 8

• days: transient breakdown
  > circulatory: AHF- pulmonary congestion (low output)
  > cardiac: acute left ventricle dilation, early hypertrophy

Question 9

Progression of HF Weeks; cardiac and circulatory

Answer 9

Circulatory: stable hyperfunction
- improved pulmonary congestion and CO
Cardiac: established hypertrophy

Question 10

Progression of HF: months circulatory and cardiac

Answer 10

Circulatory
- pressure LVHF
Cardiac
- hypertrophy and fibrosis

Question 11

JVD in heart failure

Answer 11

• present only in with RVHF

Question 12

S3/S4 in HF

Answer 12

• S3: early in diastole coincident with rapid ventricular filling
• S4: atrial kick, late diastole typically assoc with LVHF/ischemia

Question 13

Pulsus alternans

Answer 13

• alternating strong and weak pulses indicating advanced HF

Question 14

Management of acute HF or acute decompensating HF

Answer 14

• ABCs: O2
• IV access
  > diuretics
  > nitro
  > morphine

Question 15

Increased pulmonary wedge pressure and pulmonary artery pressure with murmur heard best at left 5th IC space

Answer 15

• mitral stenosis