Heart Failure

Question 1

What heart sound defines Left Ventricle systolic heart failure?

Answer 1

S3

Question 2

What heart sound defines Left heart Diastolic failure?

Answer 2

S4

Question 3

What is the usual cause of Right side heart failure?

Answer 3

Pulmonary Hypertension

Question 4

How is Heart Failure Dx?

Answer 4

Echocardiogram

Question 5

List the New York Heart Classification (primarily for systolic heart failure)

Answer 5

I Asymtomatic
II symptomatic with moderate exertion
III symptoms with minimal exertion
IV symptoms at rest

Question 6

PRO BNP is a lab for what? and what is the physiology?

Answer 6

• BNP is a lab to check for heart failure
• when the heart is stretched/dilated it releases BNP in the blood, and tells the kidneys to get rid of some of this volume stretching my heart

Question 7

What can be done for tx of heart failure which can increase ejection fraction?

Answer 7

-AICD pacemaker can make stronger contractions

Question 8

A thin walled, week, left ventricle describes what heart condition?

Answer 8

Systolic left heart failure

Question 9

What is the No 1 cause of left systolic heart failure?

Answer 9

-AMI

then cocaine, viral, radiation/chem tx

Question 10

What does the S3 sound mean?

Answer 10

-it means you have left systolic heart failure

Question 11

What are the sx of left systolic HF?

Answer 11

• dyspnea with walking
• PND, post nocturnal dyspnea, wake up short of breath and then walk around
• orthopnea, need to sleep with pillows

Question 12

What are the PE findings for left systolic heart failure?

Answer 12

• rales/crackles

- apical impulse displaces downward and to the left

Question 13

When palpating the heart apex in its normal left side and midclavicular line at the fifth intercostal space you feel an apical lift what does this tell you.

Answer 13

-tells you the person has LVH

Question 14

An echo says the patient has left ventriclular hypertrophy and an ejection fraction less than 40% tells you what?

Answer 14

-they have left systolic heart failure

Question 15

You see a patient of yours in the ER. You have been treating him for chronic left systolic heart failure. He has been on ACEI, Bblocker, and 20 mg diuretic. Now he is short of breath and unstable. How do you treat.

Answer 15

1) give Oxygen
2) stop the Bblocker, this make acute HF worse
3) Give Nitroglycerin
4) double the dosage of diuretic, now give it IV

Question 16

For chronic left ventricular heart failure you should be treating with these three medications for control?

Answer 16

• ACEI
• Bblocker
• loop diuretic

Question 17

A hypertrophic or thick ventricular wall that will not relax. It is a stiff ventricle.

Answer 17

Left diastolic heart failure

Question 18

An older lady or a Black comes in with sudden shortness of breath and elevated blood pressures, forgot to take BP meds. S4 heart sound is noted. Rales are noted. Dyspnea is noted. An apical heave is noted due to big thick left ventricle. Whats she got?

Answer 18

ACUTE Left diastolic heart failure

echo will show her ejection fraction will be normal and will show LVH

Question 19

Compare tx of chronic and acute Left diastolic heart failure

Answer 19

Chronic, tx with ACIE or Bblocker or CCB (this is not a volume problem so you don’t need a loop diuretic)

Acute, ACEI, loop diuretic, Nitro, O2 (just like left systolic heart failure)

Question 20

You can use digoxin in Left systolic heart failure, what about left diastolic heart failure?

Answer 20

Never use digoxin in left diastolic HF, you have a too thick left ventricle and we don’t want to make it even more difficult for them to contract

Question 21

Guy presents with leg edema, JVD, liver enlargement, PMI displaced toward the right sternal border apical impuse. He has no rales/crackels. What do you suspect? How do you make a definitive Dx?

Answer 21

• right heart failure
• Dx initial by echo with doppler, then gold standard is right heart catherization

but look for things that might mimic right heart failure like tamponade, and constrictive pericarditis

Tx the underlying cause of the right heart failure

Question 22

You see a guy with JVD and clear lungs, what might you suspect?

Answer 22

right heart failure

Question 23

Metabolic demand is more than the heart can pump at maximum

Answer 23

High cardiac output failure

Question 24

young lady comes in with tachycardia at rest, what might be the cause of her high cardiac output failure?

Answer 24

• thyroid storm
• severe anemia
• shunts
• berry-berry or thiamine deficiency

Question 25

Hypotension with hypo-purfusion despite adequate left ventricular filling

Answer 25

Cardiogenic Shock

Question 26

Left ventricle fills ok but is too weak to pump it out to the body

Answer 26

Cardiogenic Shock

Question 27

The number one cause of cariogenic shock is?

Answer 27

AMI

Question 28

Meds to tx cardiogenic shock

Answer 28

-fluids

• Dobutamine
• Norepinephrine

Balloon pump in aorta into the atrium which forces more blood to the coronary arteries