Heart Failure

Question 1

what findings can help distinguish heart failure w/ other causes of dyspnea?

Answer 1

Elevated serum BNP> indicated heart failure

Question 2

Whatis the MOST COMMON CAUSE OF HF?

Answer 2

IHD

Ur mycocardium could have been damaged!

Ex: previous MI, myocardial stunning, epicardial coromory disease, abnormal microcirculation, edothelial dysfunction

Question 3

Describe the vicous cycle of HF.

Answer 3

So, in HF, our story begins when we have less CO, so less perfusion will go to kidneys!, kidney will respond by activation RAAS!> ull get na and water reabsorption! BLOOD VOLUME increases! :(

Question 4

when the cause of heart failure is not clear from clinical evaluation, the first step is to determine……

Answer 4

whether systolic dysfunction is normal or depressed

via echocardiography

Question 5

what can cause Righ HF?

Answer 5

can be secondary to LVF or due to any other pulmonary problems leading to pulmonary hypertension (Cor Pulmonale)

Question 6

What is Cor Pulmonale?

Answer 6

Isolated Right HF due to pulmonary cause

Question 7

how can u treat the heart failure symtoms of Pulmonary and systemic congestion?

Answer 7

dietry sodium restriction & diuretics

Question 8

what would u do to increase patents CO in Heart failure?

Answer 8

give Vasodilators & positive inotropic drugs

Question 9

what r the 5 main goals of therapy in patients with chronic HF & reduced ejection fraction?

Answer 9

1) identify and correct the underlying condition CAUSING HF
2) elimination of acute precipitating cause of symptoms
3) Management of HF symptoms
4) Modulation of neurohormonal response
5) Prolongation of long term survival

Question 10

What do dieuretics do? how can they help with treatment of HF?

Answer 10

diuretics promote elimination of Na+ and water reabsorption, therefore decreasing intravascular volume and decreasing VR to heart. this will decrease LV PRELOAD>

Question 11

when do we use diuretics in HF?

Answer 11

only when there is pulmonary congestion (rales) and peripheral interstitial pulmonary oedema.

Question 12

what id meant by the term ‘Rales’

Answer 12

clicking, rattling, or crackling noises that may be made by one or both lungs of a human with a respiratory disease during inhalation.

Question 13

Which diuretics r the most potent during HF?

Answer 13

those that act on the loop of Henle Ex: furosmoide, trosemide,)

Question 14

which diuretic is less effective?

Answer 14

Thiazides.

Question 15

define heart failure

Answer 15

which the heart fails to maintain an adequate circulation (CO) for the needs of the body despite an adequate filling pressure’.

Or

a condition in which the heart fails to discharge its content properly

Question 16

􏰀 explain the pathophysiology of heart failure

Answer 16

Ur notes

But it starts off as a forward flow problem!

Question 17

how can left sided heart failure cause R sided HF?

Answer 17

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

Question 18

what is congestive HF?

Answer 18

when both ventricles r effected (biventrical HF

Question 19

what r some compensatory mechanism that occur during heart failure?

Answer 19

1) frank-starling mechanism
2) Neuro-hormonal activation
3) Development of ventricular hypertrophy
4) Development of Ventricular remodelling

Question 20

what is r some of the neuro-hormonal compensatory mechanisms?

Answer 20

• sympathetic Nervous sytem
• RAAS
• nuetratic hormones
• ADH
• Endothelin
• Prostaglandin/NO
• Kallikrein system
• TNF-a

Question 21

Name 3 of the most IMPORTANT neuro-hormonal compensatory mechanisms? what is their goal?

Answer 21

1- adrenegernic Nervous system
2- RAAS
3- ADH

-increase systemic vascular resistance to maintain adequate perfusion to vital organs even when there is reduced CO

REMEBER
BP=CO X TPR

-also, they increase salt and water RETENTION> increase in intravascular volume and LV preload>maximising SV via frank starling mechanism

Question 22

**acute effects of euro-hormonal compensation is beneficial, but chronic activation will be bad for Heart

Answer 22

ok

Question 23

what is the role of the adregernic system in compensating?

Answer 23

a fall in CO is ssensed by the bar receptor in the aortic arch and carotid sinus, due to the Fall in BP, they will stop firing to the CVS centre in the brain in medulla, as a result, parasympathetic flow will cease and sympathetic flow will occur.

• Increases in HR
• Stimulate a1 recepter>vasonconstrion of BV
• increase contractility

Question 24

Other than IHD what r other causes of HF?

Answer 24

Other causes of HF:
– Hypertension
– Dilated Cardiomyopathy:
• Bugs (Viral/ Bacterial / Mycobacteria) 
• Alcohol / Drugs / Poisoning
 • Pregnancy 
• Idiopathic
– Valvular Heart Disease / Congenital
– Restrictive Cardiomyopathy e.g. amyloidosis
– Hypertrophic Cardiomyopathy
– Pericardial disease
– High-Output Heart Failure
– Arrhythmias

Question 25

• Cardiac Output ~
• Stroke Volume ~
• LV end systolic volume ~
• LV end diastolic volume ~
• Ejection Fraction 50% plus
• Weight ~

Answer 25

• Cardiac Output ~ 5 litres/min
• Stroke Volume ~ 75 ml / beat
• LV end systolic volume ~ 75 ml
• LV end diastolic volume ~ 150 ml
• Ejection Fraction 50% plus
• Weight ~ 330 g

Question 26

What is endothelin?

Answer 26

Secreted by vascular ceLl and is a renal vasocomsteictoe acting locally thus activating RAAS.

IT IS INCREASED In HF :(

Question 27

orthopnea symtooms! Is VERY specific to HF,

Bc patients with copd or whatevs, dont really get orthopnea

Answer 27

Ok

Question 28

When checking for systemic edmea in HF, which leg is most likely to pit due to edema and why?

Answer 28

The left, im the peripheral leg

Question 29

HF is a forward flow problem to start with ok?

Answer 29

Ok

Question 30

CHRONIC HF is

A clinical syndrome caused by an abnormality of the heart and recognised by a characteristic pattern of renal, neural, and hormonal responses”

Answer 30

Ok

Question 31

How much fluid should there be in an effusion before you see it in a chest xray?

Answer 31

1/2 liter! 500ml