Heart Failure

Question 1

Define

Answer 1

Condition that develops when heart’s muscle becomes weakened after it is injured and fails to pump enough blood to meet needs of body

Question 2

Heart failure is a ___ caused by ___

Answer 2

syndrome

multiple disorders

Question 3

Heart failure definition by ACC/AHA

Answer 3

Clinical syndrome that results from any strucutural or functional cardiac disorder that impairs the ability of the ventricle TO FILL WITH and/or EJECT BLOOD

Question 4

Risk factors for developing HF

Answer 4

High BP
High cholesterol
Obesity
Alcohol use
Smoking
Poor diet
Physical inactivity 
Diabetes

Question 5

High BP as risk factor - treatment goal

Answer 5

Keep it under 140/90 (if no diabetes or kidney disease)

Question 6

High cholesterol as risk factor - treatment goal

Answer 6

Less than 200

Question 7

Obesity as risk factor - treatment goal

Answer 7

weight reduction to BMI of less than 30

Question 8

Alcohol use as risk factor - treatment goal

Answer 8

LImit to 1-2 drinks per day for men, 1 per day for women

Question 9

Smoking as risk factor - treatment goal

Answer 9

Cessation

Question 10

Poor diet as risk factor - treatment goal

Answer 10

Limit sodium intake, diet high in K/Ca

Question 11

Physical inactivity as risk factor - treatment goal

Answer 11

Aerobic activity 20-30 min. minimum (3-5 times per week)

Question 12

Diabetes as risk factor - treatment goal

Answer 12

Keep it under control

Question 13

What causes heart failure

Answer 13

injury to the heart from MI, CAD, idiopathic, viral infection, high BP, damage to valves, diabetes, age, alcohol, toxins

Question 14

Heart gets injured and then what happens to CO

What systems does this activate

Answer 14

reduced

Question 15

Reduced CO and myocardial injury leads to what

Answer 15

Dec baroreceptor stimulation

Dec renal perfusion

Question 16

Dec baroreceptor stimulation and Dec renal perfusion leads to what

Answer 16

Inc SNS - adrenergic system (inc in cetcholamines) and inc in renal angiotensin system

Question 17

Activation of SNS does what

Answer 17

Inc HR - problem with that though is that the sore mm has to work more - oxygen demand of that mm goes up (myocardial toxicity)

Question 18

Activation of RAAS does what

Answer 18

You dont have enough blood - so VC to redistribute the blood - the pump is working harder now though - inc afterload and preload - there is inc resistance

Question 19

What happens after activation of SNS and RAAS and their impacts

Answer 19

Negative remodeling

Worsened LV function

Question 20

Why is negative remodeling bad

Answer 20

The cells rearrange but they will never be the same again - this leads to symptoms of heart failure

Question 21

SNS inhibited by

Answer 21

beta blockers

Question 22

RAAS inhibited by

Answer 22

ACE inhibitors

Question 23

if left heart is failing - where is the backflow of fluid

Answer 23

lungs - shortness of breath

Question 24

What do you hear when there is fluid in the lungs

Answer 24

crackles at the end of inspiration

Question 25

Myocardial disarray

Answer 25

Remodeling - there is disorganized alignment leading to arrhythmia

Question 26

Ejection fraction is what

Answer 26

the fraction of blood the heart pumps out with each beat

Question 27

Healthy heart EF

Answer 27

55% | 55% should get ejected

Question 28

Abnormal heart EF

Answer 28

50% or less

Question 29

Hemorrhage - Pressures and Resistance and CO

Answer 29

Pressures - low Resistance - high CO - normal of reduced

Question 30

Sepsis - Pressures and Resistance and CO

Answer 30

Pressures - low Resistance - low CO - increased

Question 31

CHF - Pressures and Resistance and CO

Answer 31

Pressures - elevated Resistance - high CO - reduced

Question 32

Systolic heart failure

Answer 32

heart failure with reduced ejection fraction | Pumping out of heart isnt working well - it doesnt contract well

Question 33

Diastolic heart failure

Answer 33

heart failure with preserved ejection fraction | Hard to filling up - dec filling volume - cant get enough blood in the pump, so you dont have enough coming out

Question 34

Systolic dysfunction - during diastole

Answer 34

the enlarged ventricles fill with blood

Question 35

Systolic dysfunction during systole -

Answer 35

the ventricles pump out less than 40-50% of the blood

Question 36

Diastolic dysfunction - during diastole

Answer 36

The stiff ventricles fill with less blood than normal

Question 37

Diastolic dysfunction - during systole

Answer 37

The ventricles pump out 60% of the blood, but the amount may be lower than normal

Question 38

Heart failure - what comes to mind first

Answer 38

left systolic

Question 39

Diastolic heart failure can be due to

Answer 39

Pressure overload Ischemia Hypertrophy MI

Question 40

Diastolic heart failure causes

Answer 40

Abnormal relaxation and increased stiffness

Question 41

D - abnormal relaxation and inc stiffness leads to

Answer 41

elevated LV filling pressures - less output | - backflow

Question 42

Diastolic - contraction is ___

Answer 42

good because thick | you would want to use digitalis, muscle relaxation

Question 43

Systolic -

Answer 43

mm is weak - we want to dec workload of the muscle | digitalis, ace inhibitors

Question 44

Left ventricular failure

Answer 44

Elevated LV pressure | Backflow transmitted backwards to the LA, pulm veins leading to pulm congestion = pulm edema

Question 45

Right ventricular failure

Answer 45

Elevated RV pressure Backflow transmitting to RA leading to venous edema - systemic congestion Can result in hepatomegaly, mesentary and bowel edema, lower leg edema, ascites

Question 46

Left ventricular failure can progress to

Answer 46

Right ventricular failure

Question 47

Heart failure sx

Answer 47

``` Dyspnea on exertion Orthopnea Paroxysmal nocturnal dyspnea (wake up because of it) Fatigue, reduced exercise capacity Abdominal bloating, discomfort, anorexia Edema ```

Question 48

Physical exam findings

Answer 48

``` jugular venous distention hepatojugular reflux lung crackles hepatomegaly, pulsatile liver Ascites Pedal edema Cool extremities ```

Question 49

cardiac exam findings

Answer 49

``` Parasternal lift +/- S3 distention of cord tendinae S4 contraction against stiff ventricle +/- systolic murmur Pulsus alternans - variability in it ```

Question 50

Common tests for heart failure

Answer 50

ECG Chest x-ray Echocardiogram Labs - BNP or Pro BNP = if negative it is unlikely they have heart failure, pos - doesn't say much

Question 51

Beta blockers have a cardiac ___ effect

Answer 51

protective

Question 52

Device therapies

Answer 52

Implantable cardioverter defibrillator Bi ventricular pacemaker Replacement