Heart Failure

Question 1

Which hypertrophy mechanism is a compensatory mechanism of Increased STIFFNESS, NON-COMPLIANCE, and INCREASED PRESSURES?

Answer 1

CONCENTRIC HYPERTROPHY

Question 2

Which hypertrophy mechanism is a compensatory mechanism of INCREASED VOLUME chamber dilatation?

Answer 2

ECCENTRIC HYPERTROPHY - Replication of sarcomeres in series + Increased thickness
“Think EJECTION VOLUME” - Eccentric, volume

Question 3

What are the two main pathophysiologic and related clinical outcomes of LEFT-SIDED HEART FAILURE?

Answer 3

1. PULMONARY CONGESTION = Backup of blood volume into right side of heart: Increased volume -> Increased hydrostatic pressure -> Increased pulmonary edema = DYSPNEA + PND + ORTHOPNEA + CRACKLES
2. DECREASED FORWARD PERFUSION -> RAAS activation = Lack of blood flow to the kidneys (systemic perfusion) and DECREASED ECV

Question 4

Why do pts get PND and ORTHOPNEA with LEFT SIDED HEART FAILURE?

Answer 4

PND + ORTHOPNEA: Pt is lying down (PND- hours, orthopnea - few mins) -> Lying down increases venous return (remove gravity) -> INCREASED PRELOAD to heart, but heart can not appropriately eject out extra stroke volume -> INCREASES Pulmonary congestion -> Pulmonary edema

Question 5

Why do pts get CRACKLES with LEFT-SIDED HEART FAILURE?

Answer 5

Pulmonary congestion -> Increased hydrostatic pressure -> Increased fluid in the interstitial space of lung = crackles

Question 7

What is the histologic hallmark of LEFT SIDED HEART FAILURE?

Answer 7

HEART FAILURE CELLS - Small engorged pulmonary capillaries burst -> INTRA-ALVEOLAR HEMORRHAGE (contains lots of Fe) -> Gets eaten up by macrophages
HEART FAILURE CELLS = HEMOSIDERIN-LADEN MACROPHAGES

Question 8

What is the Tx of LEFT SIDED HEART FAILURE?

Answer 8

ACE INHIBITOR**
To prevent the downward spiral of Decreased ECV-mediated RAAS activation (Peripheral vasoconstriction - increased afterload + Aldosterone - increased volume retention exacerbating left sided HF)

Question 9

What is the most common cause of RIGHT-SIDED HEART FAILURE? What are two other possible causes?

Answer 9

1. LEFT SIDED HEART FAILURE = most common
2. L->R shunt
3. Chronic lung disease (cor pulmonale) - Generalized hypoxia -> Hypoxia-mediated vasoconstriction -> Right heart has to work harder to feed into the pulmonary artery

Question 10

What is cor pulmonale? What conditions cause cor pulmonale? Which heart failure does this result in?

Answer 10

Hypoxemia -> Generalized hypoxia -> Constriction of pulmonary arterioles -> Pulm HTN -> Right sided Heart failure = COR PULMONALE

1. CHRONIC BRONCHITIS
2. LATE-STAGE** EMPHYSEMA: Not in early stages since it is only regional hypoxia and can be compensated for by pursing lips
3. BRONCHIECTASIS

Question 11

What are the three main pathophysiologic and related clinical outcomes of RIGHT-SIDED HEART FAILURE?

Answer 11

Right sided heart failure - Sx based on congestion of structures feeding into RA

1. JVD - Jugular vein congestion
2. Splenic vein + Portal vein - Painful HSM + NUTMEG liver + CARDIAC CIRRHOSIS (long-standing)
3. Systemic LE veins - Dependent pitting edema

Question 12

What type of hypertrophy does an MI result in? What type of dysfunction results due to decompensated heart failure?

Answer 12

MI -> Irreversible damage of a portion of the myocardium -> Volume overload for the remaining viable myocardium -> Dilation and enlargement of chambers -> ECCENTRIC HYPERTROPHY -> Impaired contractility -> Systolic Dysfunction