Heart Failure

Question 1

Why were/is there such big disparities between women and men in terms of HF?

Answer 1

Because there was a lot of underrepresentation of cardiac studies in women, less effective treatment

Question 2

Heart failure

Answer 2

-a complex SYNDROME, not a disease!

Question 3

Heart failure symptoms

Answer 3

-Shortness of breath
-Exercise limitation and fatigue
-clinical signs of peripheral and/or pulmonary congestion
and secondary to abnormalities of cardiac structure and function

Question 4

Typical patients

Answer 4

Eldery, neurological decline, anxiety/depression, low O2, high jugular pressures, faitigued, fast heart rate. Peripheral oedema.

Weak pulse.

Question 5

Left-side heart failure

Answer 5

Usually occurs first

• Lung “crackles”
• Tachycrdia
• Low Sp02
• paroxysmal nocturnal dyspnea
• GI symptoms
• cool/pale extremities
• weight gain

Question 6

Right sided heart failure

Answer 6

Usually Secondary

• Jugular venous distention
• Liver engorgement
• Ascites
• Peripheral edema
• Weight gain

Question 7

Physical Findings

Answer 7

• Tachycardia, irregular pulse, elevated jugular venous pressure
• a 3rd heart sound
• peripheral oedema

Question 8

Investigated

Answer 8

ECG, BNP (stretch of heart> naturiectic peptide), chest X-ray, echo

Question 9

Two main types of heart failure

Answer 9

HFrEF: reduced ejection fraction/ systolic heart failure

HFpEF: preserved ejection fraction/ diastolic HF

Question 10

HFrEF: reduced ejection fraction/ systolic heart failure

Answer 10

Very large heart, with very thin wall, so cant eject properly

Symptoms when EF

Question 11

HFpEF: preserved ejection fraction/ diastolic HF

Answer 11

Very thickened ventricular wall, smaller lumen so cant fill

• increased stiffening of heart (collagen)
• increased EDP
• increased collagen

Symptoms when EF >50%

Question 12

Ejection Fraction (%)

Answer 12

Amount of blood pumped OUT of ventricle/total amount of blood IN ventricle

Normal EF: 55-70%

((EDV-ESV)/ EDV) x100

Question 13

Shared and differences of HFrEF and HFpEF

Answer 13

Shared: ageing, obesity

HFrEF: men, smoking, MI

HFpEF: women, renal dysfunction, atrial fibrillation

Question 14

How does myocyte architecture change

Answer 14

HFrEF: stretching of myocyte cells

HFpEF:thickening of myocyte

Question 15

HFrEF / systolic HF PV loops

Answer 15

-can’t generate high enough pressures, reduced ability to contract at the same volume.

then:
increases Volume to compensate (increased venous return)

Question 16

HFpEF/diastolic HF PV loops

Answer 16

-Increase in the preload, and the inability of the heart to relax. (increased venous return)

Question 17

LaPlae’s Law predictiom

Answer 17

1st: HFrEF; increasing radius leads to increased tension
2nd: HFpEF; that increased tension can be reduced by wall thickening, but at the expense of filling

Question 18

Draw the vicious cycle of heart failure

Answer 18

Myocardial injury
d. ventricular performance
d. CO
activation of neurohumoral system (i. sympathetic activity)
VC, Na+ and water retention
i. demand on the heaart

Question 19

Draw progression of heart failure flow diagram

Answer 19

…

Question 20

In decompensated HF

Answer 20

Can never get back to normal CO

Question 21

If we can’t return CO fully back to normal, what do we try to do for HF patients

Answer 21

We just try to manage symptoms; diuretics, ACE inhibitors, B-blockers etc.

Manage weight (fluid balance) on a day-to-day basis

ICD or cardiac resynchronisation therapy

assist devices

transplant (usually younger acute patients)