Heart Failure

Question 1

What are the most common causes of left-sided heart failure?

Answer 1

Ischemic heart disease, Hypertension, mitral and aortic valvular disease, myocardial disease (cardimyopathy, myocarditis).

Question 2

What is the Pulmonary Capillary Wedge Pressure?

Answer 2

It is a good approximation of left atrial pressure.

Question 3

How do we measure the PCWP?

Answer 3

Measured with Swan-Ganz catheter.

Question 4

Where will we put the Swan-Ganz catheter?

Answer 4

It is a venous catheter, who it’s put in either in the internal Jugular vein or the subclavian vein.

Question 5

What do we measure with the Swan-Ganz catheter?

Answer 5

Measure Left Atrial pressure and and approximates left ventricular diastolic pressure.

Question 6

What is the normal pressure of the PCWP?

Answer 6

PCWP

Question 7

What is the normal pressure of the Left Atrial?

Question 8

What is the normal pressure of the Left ventricular pressure?

Answer 8

Around 10 mmHg.

Question 9

How are the pressures in Mitral Stenosis?

Answer 9

Pulmonary Capillary Wedge Pressure > Left Ventricular diastolic pressure.

Question 10

What is a Heart Failure?

Answer 10

It’s a clinical syndrome caused by abnormal cardiac structure or function (cardiac pump dysfunction). Acquired and inherited.

Question 11

Which are the symptoms finding in Heart failure?

Answer 11

Exercise intolerance, Fatigue, Shortness of breath, pulmonary rales, peripheral edema, pitting edema, dyspnea, Orthoptnea and JVD.

Question 12

Which are the causes of decrease left ventricular contractility?

Answer 12

Chronic Hypertension (most common) and Ischemic cardiomyopathy.

Question 13

What are the compensation of the decrease of cardiac output?

Answer 13

Increases sympathetic activation and Increases Renin-Angiotensin-Aldosterone.

Question 14

What is the short term mechanism to regulate the blood pressure?

Answer 14

It is the activation of the systemic nervous system that increase Left Ventricular contractility resulting in elevation of cardiac output

Question 15

What are the three ways to stimulate renin production?

Answer 15

1) Sympathetic nervous system stimulating Beta1- receptors on the kidneys.
2) Macula densa cells sense low sodium.
3) Juxtaglomerular apparatus sense low Blood Pressure.

Question 16

What is the function of Renin?

Answer 16

Convert angiotensinogen to angiotensin I, after that in the lungs ECA convert angiotensin I to angiotensin II.

Question 17

What organs are involved in Renin-Angiotensin-Aldosterone ?

Answer 17

Kidneys making Renin, Liver making Angiotensinogen and Lungs making ACE, Adrenal gland making Aldosterone.

Question 18

What is the most potent Vasoconstrictor in the human body?

Answer 18

Angiotensin II. Also stimulates adrenal glands to secrete aldosterone.

Question 19

What are the functions of the angiotensin?

Answer 19

Directly increase blood pressure by vasoconstriction, and indirectly increase blood pressure while expanding intra vascular volume.

Question 20

What is the function of compensation in Heart failure of the renin-angiotensin-aldosterone?

Answer 20

R-A-A increases renal sodium and water absorption that increase systemic venous pressure and preload and finally that increase cardiac output.

Question 21

What is the side effect of the increase systemic venous pressure and increase of preload during the compensation?

Answer 21

Peripheral edema (pitting edema).

Question 22

Decrease Left ventricular contractility resulting in pulmonary venous congestion, what are the effects that this cause?

Answer 22

First one cause Pulmonary edema also decrease Right ventricle output that resulting in peripheral edema,

Question 23

How many categories of Heart failure exist?

Answer 23

There are two broad categories Left heart failure and Right heart failure.

Question 24

Left-sided heart failure characteristics:

Answer 24

Dyspnea on exertion (DOE).
Cardiac dilation. 
Pulmonary edema:
-Paroxysmal nocturnal dyspnea. 
-Orthoptnea.

Question 25

Right-Sided heart failure:

Answer 25

Peripheral edema: 
-Pedal edema.
-Pre-sacral edema.
Jugular venous distention (JVD).
Hepatic congestion.

Question 26

How looks the liver in biopsy or autopsy in Right sided heart failure?

Answer 26

Nutmeg liver appearance.

Question 27

What is the BNP?

Answer 27

Brain natriuretic peptide is a hormone that is produced by cardiac cells in response to ventricular stretch.

Question 28

What does the BNP do?

Answer 28

It is a diuretic hormone, Causes vasodilation and increase excretion of a sodium and water in urine.

Question 29

How do you make the diagnosis of CHF with Serum BNP level ?

Answer 29

BNP elevated about 100 make the diagnosis of CHF.

Question 30

What are the signs of right-sided heart failure?

Answer 30

Peripheral signs and symptoms:
Lower extremity edema.
Jugular venous distention.
Hepatosplenomegaly.

Question 31

What are the signs of left-sided heart failure?

Answer 31

Pulmonary symptoms:
Dyspnea on exertion.
Orthopnea.
Paroxysmal nocturnal dyspnea.
Pulmonary edema -> rales.

Question 32

How does poor cardiac output result in an increase in aldosterone?

Answer 32

Decrease cardiac output result in low blood pressure that is detected by Juxtaglomerular cells in the kidney and these cells secrete renin which activates the RAAS resulting in increases of aldosterone.