Heart Failure

Question 1

Heart Failure Basic components

Answer 1

1) Poor forward blood flow = low flow (decr cardiac ouput)

2) Backward buildup of pressure = congestion (incr filling pressures) as a response to low flow

Question 2

3 factors that affect stroke volume

Answer 2

1) preload (incr sv)
2) afterload (decr sv)
3) inotropy (incr SV)

Question 3

2 factors affecting CO

Answer 3

1) HR (incr CO)

2) SV (incr CO)

Question 4

Effect of Preload on Stroke volume vs. Ventricular EDP

Answer 4

increased filling of ventricle, incr ventricular output (SV)

Question 5

the more LV is filled, the ____

Answer 5

more it will contract

Question 6

the ____ the more it will contract

Answer 6

more LV is filled

Question 7

incr ___ produces increased SV and CO for given inotropic state

Answer 7

Preload

Question 8

incr preload increases ___ and ____ for given inotropic state

Answer 8

SV and CO

Question 9

Effect of inotropy on SV vs. ventricular EDP curve

Answer 9

shifts curve upwards

Question 10

Same filling (preload) of LV produces a ___

Answer 10

greater squeeze of contraction

Question 11

Determinants of inotropy

Answer 11

catecholaminergic/adrenergic stim

calcium

Question 12

incr inotropy produces increased ___ and ____ for the same preload

Answer 12

SV and CO

Question 13

incr ____ produces increased SV and CO for the same preload

Answer 13

inotropy

Question 14

Effect of increased preload on PV loop

Answer 14

increased end diastolic pressure (more filling on the LV)

Question 15

Effect of increased inotropy on PV loop

Answer 15

increased pressure (height) and decr end systolic volume

pump with greater force and empty more of the LV

Question 16

effect of increased afterload on PV loop

Answer 16

increased end systolic volume and increased pressure

have to pump with more force against higher resistance and empty LESS of LV

Question 17

Systolic HF basics

Answer 17

weak/damaged myocardium (thinner walls)

Question 18

Systolic HF problem

Answer 18

problem with squeeze

decr contraction and decr inotropy

Question 19

hallmarks of systolic dysfunction

Answer 19

decreased ejection fraction

ventricular enlargement

Question 20

PV loop with systolic HF

Answer 20

decr top pressure line and shift curve to the right

decr inotropy, decr SV (pump out less) and lower systolic blood pressure b/c less force

incr end diastolic volume b/c walls are thinner

Question 21

Primary causes of systolic HF

Answer 21

1) direct destruction of heart muscle cells
2) overstressed heart muscle
3) volume overloaded heart muscle

Question 22

causes of Direct destruction of heart muscle cells

Answer 22

MI
viral myocarditis
peripartum
dilated cardiomyopathy
alcohol

Question 23

causes of Overstressed heart muscle

Answer 23

tachycardia mediated HF
meth use
stress provoked

Question 24

causes of volume overloaded heart muscle

Answer 24

mitral regurg
high cardiac output
- shunting of blood
- wet beriberi

Question 25

Diastolic HF basics

Answer 25

stiff/noncompliant heart

Question 26

Diastolic HF problem

Answer 26

impaired filling

decr lusitropy

Question 27

hallmark of diastolic HF

Answer 27

normal ejection fraction

ventricular wall thickening

Question 28

PV loop in diastolic HF

Answer 28

incr bottom pressure line, decr top pressure line, decr end diastolic volume

incr stiffness so need higher baseline pressure to keep stiff wall open
can’t fill as much blood due to thick walls
decr top pressure line due to stiffer walls

Question 29

causes of diastolic HF

Answer 29

1) High afterload / pressure overload
2) Myocardial thickening / fibrosis
3) External compression

Question 30

causes of High afterload / pressure overload

Answer 30

longstanding HTN
aortic stenosis
dialysis

Question 31

causes of mycoardial thickening/fibrosis

Answer 31

HCM

primary restrictive cardiomyopathy

Question 32

causes of external compression

Answer 32

pericardial fibrosis/constrictive pericarditis

pericardial effusion

Question 33

Right sided HF

Answer 33

can’t pump blood through lungs adequately

Question 34

Right sided HF

what causes forward RV HF

Answer 34

decr circulating blood flow

Question 35

Right sided HF

what causes backward RV HF

Answer 35

incr venous pressure

Question 36

Primary causes of right sided HF

Answer 36

1) Left sided HF
2) lung disease/pulmonary HTN/RV pressure overload
3) RV volume overload
4) damage to RV myocardium

Question 37

why does left heart failure cause right heart failure

Answer 37

backward HF stresses right side by incr pulm venous pressures

Question 38

Do HF forms coexist?

Answer 38

Yes

with fibrosis and ischemia

Question 39

Body’s compensatory responses to decr cardiac output in heart failure

Answer 39

1) neurohormonal activation
2) frank-starling (incr preload)
3) ventricular hypertrophy and dilation

Question 40

Normal response to decr cardiac output (JGA route)

Answer 40

1) dehydration or bleeding
2) decr LV filling, decr CO
3) juxtaglomerular apparatus sense low flow and activ renin system

4) incr sodium retention
5) activate vasoconstriction

6) incr volume and incr LV filling

Question 41

Normal response to decr cardiac output

Answer 41

1) dehydration or bleeding
2) decr LV filling, decr CO
3) baroreceptors sense lower pressure

4) adrenergic activation
5) incr HR and vasoconstriction
6) incr blood volume and incr LV filling

Question 42

Neurohormonal compensatory mechanism- additional effect

Answer 42

supranormal filling pressures

Question 43

HF effect on SV vs. ventricular end diastolic pressure curve

Answer 43

shift down

given pressure, less stroke volume

Question 44

Frank Starling compensation

Answer 44

incr LV filling

incr SV

stroke volume preserved by increasing end diastolic filling and pressure

Question 45

Vascular remodeling via hypertrophy and dilation

Long term incr in cardiac workload and metab demand
4 things

Answer 45

1) ventricular hypertrophy
2) ventricular dilation
3) myocardial damage/apoptosis
4) myocardial fibrosis

Question 46

Vascular remodeling via hypertrophy and dilation

Overtime remodeling causes (3)

Answer 46

1) decr contractile force
2) decr dynamic function
2) incr diastolic stiffness