Heart Failure

Question 1

Define what heart failure is?

Answer 1

When the heart cannot supply sufficient blood to meet the body’s needs

Question 2

Describe the normal cardiac function of the heart?

Answer 2

1. Right atrium collects deoxygenated blood from the body parts via vena cava
2. Right atrium supplies the blood to the right ventricle and pumped to the lungs via pulmonary artery
3. Pulmonary vein collects oxygenated blood from the lungs to the left atrium
4. Oxygenated blood goes to the left ventricle and pumped to the body parts via aorta
5. Heart valves: tricuspid & pulmonary on the right; aortic & mitral on the left

Question 3

Describe what systolic heart failure (also called left and right systolic heart failure) is?

Answer 3

1. The heart fails to pump the blood out of the ventricles properly
2. The left and right side of the heart has thin and weak cardiac muscles- normally caused by cardiac muscle death

Question 4

Describe what diastolic heart failure (also called left and right diastolic heart failure) is?

Answer 4

1. When the heart fails to fill the blood efficiently from atrium to ventricles
2. Due to “Larger Cardiac Muscles” and “reduced ventricle size”
3. Usually fails in the left side of the heart first which affects other parts of the heart such as the right side
4. Same ejection fraction as theres reduced blood volume and ejection volume

Question 5

When someone experiences heart failure, what can this lead to a build up of in the body?

Answer 5

Build up of fluid which can lead to congestion in the lungs

Question 6

Define what stroke volume is?

Answer 6

The amount of blood pumped out for every beat

Question 7

How do you work out cardiac output?

Answer 7

Stroke volume x Heart rate

Question 8

What is ejection volume and how do you work it out?

Answer 8

1. Ejection volume: % of blood ejected by each beat

2. (Volume ejected/total amount of blood) x 100

Question 9

Describe the causes of systolic heart failure?

Answer 9

1. Cardiac heart disease: plaques build up which lead to blood getting to heart- leads to cardiac muscle death
2. cardiomyopathy: heart disease weakens heart muscle
3. Valve diseases: the backward flow to the atria means the heart beat needs to increase to meet the demand
4. Stenosis: narrowing of aortic and pulmonary valves
5. Cardiac arrhythmias: slow or fast heart beat is irregular, increased beating means more O2 which heart fails to meet

Question 10

Cardiac myopathy leads to hypertrophy of the heart and stiffening of muscles, describe how these two factors affect diastolic heart disease?

Answer 10

1. Hypertrophy: increase in size reduces the ventricle size
2. Stiffening of muscles: muscle cells die due to lack of O2 which leads to hardening of them- reduces overall contraction

Question 11

Describe what causes diastolic heart failure?

Answer 11

1. Chronic hypertension:
   - reduces the size of the blood vessels which means it has to work harder to pump out blood
   - Increases size of the heart and ventricles
2. Aortic stenosis:
   - narrowing of aortic valves which restricts blood growth
   - Increases muscle growth
3. Cardiac myopathy
   - hypertrophy of heart and stiffening of muscles
4. Endocarditis: infection in endocardium

Question 12

When the heart might go through heart failure, how does it compensate to try ensure it doesn’t?

Answer 12

1. Increases the sympathetic nervous system to increase cardiac activity
   - Activation of receptor mediated effects: Contraction and relaxation
   - Prolonged activation can lead to desensitisation
2. Increasing preload on the heart
   - Increase of aldosterone increases filling volume and stroke volume
   - Increase muscle activity
3. Cardiac hypertrophy
   - Size increase to increase ejection volume

Question 13

What is the “decompensation” which the heart goes through when it tries compensate for failing?

Answer 13

1. The heart needs an increase in oxygen supply to manage all its increased activity
2. It will lead to cell death if it cannot get enough

Question 14

What are the forward failure symptoms of LEFT sided heart failure?

Answer 14

1. Tiredness and fatigue: decreased blood oxygen to body leads to reduced activity
2. Decreased urination: lack of blood supply and reduction in fluid
3. Irregular heart beats: supply more blood to body parts

Question 15

What are the backward failure symptoms of left sided heart failure?

Answer 15

1. Pulmonary oedema: due to the heart not pumping efficiently, leads to fluid in lungs
2. Difficulty breathing and coughing: congestion or fluid build up
3. Weight increase: due to fluid increase

Question 16

What is forward and backward failure?

Answer 16

1. Forward: cannot pump blood to the lungs

2. Backward: when blood backs up in the body

Question 17

What are the forward failure symptoms of RIGHT sided heart failure?

Answer 17

1. Tiredness and fatigue: reduced blood supply to the lungs leads to less oxygen
2. Irregular heart beats: supply more blood to body parts

Question 18

What are the backward failure symptoms of RIGHT sided heart failure?

Answer 18

1. Oedema: fluid back up in the body (leads to congestion) extremities (legs and jugular vein in the neck)
2. Weight gain: increase in fluid
3. Increased urination: due to back up of more blood

Question 19

What are the three ways of diagnosing heart failure?

Answer 19

1. X ray: shows an enlarged heart (cardiomegaly)
2. Echocardiogram (monitor ejection fraction, valves and enlargement)
3. Blood tests:
   B-type natriuretic peptides increase of more than 100pg/ml shows heart failure

Question 20

How do you classify heart failure?

Answer 20

Treadmill or exercise activity test

Question 21

What is class I heart failure and what do the results show?

Answer 21

1. Asymptomatic heart failure

2. No effect on physical activity

Question 22

What is class II heart failure and what do the results show?

Answer 22

1. Mild heart failure
2. Mild oedema
3. Limited ability to exercise properly

Question 23

What is class III heart failure and what do the results show?

Answer 23

1. Moderate to severe heart failure
2. Comfortable only at rest
3. Noticeable limitations in exercise capacity

Question 24

What is class IV heart failure and what do the results show?

Answer 24

1. Severe heart failure
2. Symptoms at rest
3. Not able to exercise without discomfort

Question 25

Describe the early stage treatment of heart failure?

Answer 25

1. Regular exercise
2. Balanced healthy diet of reduced salt and fat
3. Anti-hypertensive drugs: ACE inhibitors, Nitrates and beta blockers

Question 26

Describe the late stages of treatment of heart failure?

Answer 26

1. Diuretics: reduce congestion in the body through removing excess fluid- reduces blood pressure
2. Aldosterone antagonists: removes excess sodium and fluid
3. Calcium channel blockers: reduces the cardiac activity and blood pressure by antagonising calcium channels
4. ACE inhibitors, nitrates and beta blockers

Question 27

Describe the mechanical devices that can be used to manage heart failure?

Answer 27

1. Ventricular assist device:
   - directly connected to the ventricle to pump out blood via the vessel
   - Can be used left, right or both
   - Used directly before heart transplant
2. Cardiac resynchronisation therapy
   - inserting pacemaker on atrium or ventricles, makes them beat at the same rate and pace
   - pacemaker with defibrillator, same as above but delivers a shock as well

Question 28

What are the surgical methods used to manage heart failure?

Answer 28

1. Coronary Angioplasty: insertion of a stent
2. CABG: Coronary artery bypass graft
3. Heart transplant