Heart failure

Question 1

What is the primary cause of systolic heart failure? Name 4 other causes as well

Answer 1

Primary cause: Ischaemic heart disease

Other causes: Hypertension
dilated cardiomyopathy (Caused by bugs, alcohol/drugs, pregnancy)
Vallvular heart disease
Hypertrophic cardiomyopathy

Question 2

four things that can affects cardiac output?

Answer 2

Heart rate
venous capacity (preload- the amount of blood going into the heart)
Afterload
Myocardial contractility

Question 3

what structural heart changes are accompanied with left ventricular systolic dysfunction?

Answer 3

Loss of muscle
Uncoordinated or abnormal myocardial contraction (you see ECG changes)
You get changes in the ECM whereby the amount of collagen increases and you get a slippage of myocardial fibre orientation

change in cellular structure and function- myocyte hypertrophy, changes in calcium avaliability and receptor regulation

Question 4

Name 8 hormones/systems related to heart failure
SNRVEPNB

Serve’n Peanut butter N jelly

Answer 4

sympathetic nervous system
RAAS
Natriuretic hormones
vasopressin
endothelin
prostaglandins
Nitric oxide
bradykinin

Question 5

Explain what effects the sympathetic nervous system has. Explain why these effects can be deleterious

Answer 5

Aims to improve Cardiac output: Increases inotropy, causes arterial and venous constriction to increase the blood pressure and causes tachycardia

In the long term, this can induce cardiac hypertrophy–>MI

Question 6

Explain the effect the RAAS has in heart failure. Explain why in the long term this can be deleterious?

Answer 6

Works to increase blood pressure by:
Vasoconstriction (Angiotensin 2)
Increased reabsorption of water in the kidneys (Aldosterone)

Question 7

Explain the effect of natriuretic peptides in heart failure

Answer 7

Released with the heart muscle is stretched
if being stretched, then blood pressure is too high
so works to decrease reabsorption of water in the kidneys and vasodilate

so opposite to RAAS and sympathetic nervous system

Question 8

Out of the hormones released in heart failure, which can be used diagnostically?

Answer 8

Natriuretic peptides

confirms for sure heart failure

Question 9

Give the actions of vasopressin, endothelin, prostaglandins, nitric oxide and bradykinin

Answer 9

Vasopressin:
•	Increases H2O retention
•	Causes tachycardia and reduces systemic resistanceIncrease CO
Endothelin
•	Activates the RAAS
Prostaglandins
•	Stimulated by NA and RAAS
•	Vasodilators on the renal arterioles to reduce the effects of RAAS and NA
Nitric oxide
•	Potent vasodilator
•	NO synthase blunted by HF
•	So loss of vasodilatation balance
Bradykinin:
•	Promotes natriuresis (Na+ loss in urine) and vasodilatation decreases bp

So overall, these work to combat the effect so RAAS and Sympathetic nervous system

Question 10

Name 4 signs of heart failure

Answer 10

oedema
increased peripheral resistance
Anaemia (multifactorial aeitology, dont worry)

Question 11

Describe the pathophysiology of heart failure with preserved ejection fraction

Answer 11

decreased compliance of left ventricle–>describe myocardial relaxation
(Due to increased deposition of collagen)

LV diastolic filling impaired and becomes reliant on LA high pressure

leads to increased pressure in the pulmonary circulation

leads to Right ventricular dysfunction

Question 12

Name 5 symptoms of left sided heart failure (2 specific, three general)

Answer 12

specific: pulmonary oedema and murmur of mitral regurgitation
general: tachycardia, cardiomegaly, tiredness

Question 13

Most common cause of right sided heart failure?

Answer 13

Left sided heart failure

Question 14

Other causes of right sided heart failure? 5

Answer 14

Chronic lung disease
PE
Pulmonary hypertension
Left to right shunt
Pulmonary/tricuspid valvular diseaese

Question 15

Name 4 symptoms of right sided hearrt failure

Answer 15

Increased venous pressure
Ascites
Enlarged liver/spleen
Peripheral oedema