Heart Failure

Question 1

What is heart failure defined as?

Answer 1

A state in which the heart fails to maintain an adequate circulation for the needs of the body despite an adequate filling pressure

Question 2

What is the primary cause of systolic heart failure?

Answer 2

Ischaemic heart disease

Question 3

Other than IHD, what are the causes of HF?

Answer 3

Hypertension 
Dilated cardiomyopathy 
Valvular heart disease 
Restrictive cardiomyopathy 
Hypertrophic cardiomyopathy 
Pericardial disease 
High-output heart failure 
Arrythmia

Question 4

What can cause dilated cardiomyopathy?

Answer 4

Bugs
Alcohol
Drugs
Poisioning
Pregnancy

Question 5

What can cause restrictive cardiomyopathy?

Answer 5

Amyloidosis

Question 6

What does the force developed in the myocardium depend on?

Answer 6

The degree to which the fibres are stretched (or how much the heart is filled)

Question 7

What happens to the force developed in the myocardium in heart failure?

Answer 7

The heart can no longer produce the same amount of force (or cardiac output) for a given level of filling

Question 8

What will be seen on the Starlings Law of the Heart Curve with heart failure?

Answer 8

In mild failure, will be less cardiac output for the same filling
In gross failure, after a point, increasing filling will result in reduced cardiac output

Question 9

What are the types of heart failure?

Answer 9

Class I
Class II
Class III
Class IV

Question 10

What will be seen in class I heart failure?

Answer 10

No symptomatic limitation of physical activity

Question 11

What will be seen in class II heart failure?

Answer 11

Slight limitation of physical activity
Ordinary physical activity results in symptoms
No symptoms at rest

Question 12

What will be seen in class III heart failure?

Answer 12

Marked limitation of physical activity
Less than ordinary physical activity results in symptoms
No symptoms at rest

Question 13

What will be seen in class IV heart failure?

Answer 13

Inability to carry out physical activity without symptoms
May have symptoms at rest
Discomfort increases with any degree of physical activity

Question 14

Does heart failure affect one or both sides of the heart?

Answer 14

Can be either

Question 15

Does right-sided heart failure occur on its own?

Answer 15

Rarely

Question 16

When may right sided heart failure occur on its own?

Answer 16

In the case of chronic lung disease

Question 17

What is the most common scenario in heart failure?

Answer 17

Left-sided heart failure that raises pulmonary arterial pressure, leading to additional right sided heart failure

Question 18

What is it called when both ventricles are affected in heart failure?

Answer 18

Congestive heart failure

Question 19

What is heart failure often divided to in clinical practice?

Answer 19

Left sided heart failure 
Right sided heart failure 
Biventricular (congestive) heart failure 
Systolic heart failure 
Diastolic heart failure

Question 20

What are the symptoms of left sided heart failure?

Answer 20

Fatigue, shortness of breath upon exertion or when lying lat, waking from sleep with shortness of breath
Tachycardia
Cardiomegaly
3rd or 4th heart sound
Functional murmur of mitral regurgitation
Basal pulmonary crackles
Peripheral oedema

Question 21

What is cardiomegaly?

Answer 21

Displaced apex beat

Question 22

What is it called when there is a 3rd or 4th heart sound?

Answer 22

Gallop rhythm

Question 23

When is right sided heart failure most common?

Answer 23

Secondary to left heart failure

Question 24

What can cause right sided heart failure?

Answer 24

Chronic lung disease 
Pulmonary embolism/hypertension 
Pulmonary/tricuspid valvular disease 
Left to right shunts (ASD/VSD)
Isolated right ventricular cardiomyopathy

Question 25

What are the symptoms of right sided heart failure?

Answer 25

``` Distension and fluid accumulation (peripheral oedema) in areas drained by systemic veins Fatigue Dyspnoea Anorexia Nausea Raised JVP Tendor, smooth hepatic enlargement Dependent pitting oedema Ascities Pleural effusion ```

Question 26

What is activated in heart failure?

Answer 26

The renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system

Question 27

Why are the sympathetic nervous system and RAAS activated in heart failure?

Answer 27

In an attempt to maintain cardiac output

Question 28

What effect does the activation of the sympathetic nervous system and RAAS have?

Answer 28

Making an already struggling heart work harder

Question 29

What does a drop in blood pressure, such as in heart failure, stimulate?

Answer 29

Renin release from the kidneys

Question 30

What is renin?

Answer 30

An enzyme which catalyses the conversion of angiotensin to angiotensin I

Question 31

What happens to angiotensin I?

Answer 31

It is converted to angiotensin II by ACE

Question 32

What is angiotensin II?

Answer 32

A strong vasoconstrictor

Question 33

What does angiotensin II promote?

Answer 33

Release of aldosterone from the kidneys

Question 34

What does aldosterone cause?

Answer 34

Salt and water retention in the kidneys, increasing blood volume

Question 35

What does the sympathetic nervous system cause when theres a drop in blood pressure?

Answer 35

Causes vasoconstriction of the blood vessels via the alpha 1 receptor, increasing blood pressure

Question 36

What is the result of SNS induced increased blood pressure in heart failure?

Answer 36

It increases the workload on the heart by increasing both the preload and the afterload

Question 37

What will sympathetic innervation of the hearts ß1 receptors cause?

Answer 37

An increase in both chronotropy and inotropy

Question 38

What drugs are used in the treatment of heart failure?

Answer 38

``` ACE-inhibitors Diuretics ß-blockers Ca channel blockers Organic nitrates Cardiac glycosides ```

Question 39

Why are ACE-inhibitors used in the treatment of heart failure?

Answer 39

To prevent the conversion of angiotensin I to II, and thus have an indirect vasodilatory and diuretic effect, both of which are beneficial in the treatment of heart failure by reducing the workload of the heart

Question 40

Why are diuretics used in the treatment of heart failure?

Answer 40

Reduce blood volume and thus oedema

Question 41

What are ß-blockers used to do?

Answer 41

Prevent sympathetic innervation of the myocardium in an attempt to reduce the hearts work load

Question 42

What are the principles of the management of heart failure?

Answer 42

Correct underlying cause pharmacological measures first, then pharmacological therapy. Treat complications/associated conditions/cvs risk factors

Question 43

What is the purpose of pharmacological therapy in the management of heart failure?

Answer 43

Symptomatic improvement Delay of progression of heart failure Reduce mortality

Question 44

What is the purpose of Ca channel blockers in the treatment of heart failure?

Answer 44

Reduce contractility of the myocardium

Question 45

What is the purpose of organic nitrates in the treatment of heart failure?

Answer 45

Veno/vasofilator, resulting in a reduction in BP

Question 46

What is the purpose of cardiac glycosides in the treatment of heart failure?

Answer 46

Increase CO and heart contractility by inhibiting the Na/K pump Raising intracellular Na inhibits NCX, so intracellular Ca increases, and so increase in contractility