Heart Failure

Question 1

Heart failure

Answer 1

the inability of the heart to maintain sufficient cardiac output to optimally meet metabolic demands of tissues and organs and is the end stage of most cardiac diseases

Question 2

What is involved in heart failure?

Answer 2

multiple organ systems and a progressive syndrome

Question 3

What are the results of heart failure?

Answer 3

congestion of blood in the pulmonary venous circulation

Question 4

Common causes of heart failure

Answer 4

coronary heart disease and hypertension interacting . CAD contributes to HF via endothelial cell dysfunction, ischemia and infarction.

Question 5

Congestive heart failure

Answer 5

dysfunctional cardiac pumping that results in congestion of blood behind the dysfunctional cardiac pump.
Right-sided failure: systemic venous congestion
Left-sided failure: pulmonary congestion

Question 6

What contributes to heart failure?

Answer 6

impaired ability of myocardial fibers to contract, relax or both

Question 7

How is congestive heart failure classified?

Answer 7

systolic or diastolic heart failure

Question 8

Which patients have a higher mortality rate of death from heart failure?

Answer 8

those with low ejection fraction and congestive symptoms

Question 9

What are the 4 types of heart failures?

Answer 9

1. systolic dysfunction
2. diastolic dysfunction
3. left-sided heart failure
4. right-sided heart failure

Question 10

Systolic Dysfunction

Answer 10

low ejection fraction due to reduced contractility

Question 11

What is impaired contractility attributable to?

Answer 11

MI (which is a common cause of heart failure) with cell death and loss of contractile elements reduces the heart’s contractile force

Question 12

Diastolic dysfunction

Answer 12

the left ventricle is excessively noncompliant and does not fill effectively during diastole

Question 13

What are the 2 common causes of diastolic dysfunction?

Answer 13

CAD and hypertension

Question 14

What are the 3 methods to compensate HF in order?

Answer 14

1. Increase sympathetic activation
2. increase Preload via RAAS
3. Hypertrophy

Question 15

What is the downside of compensatory mechanisms for HF?

Answer 15

over a long period of time can be detrimental to the heart

Question 16

How does activating the SNS help in an immediate response to acute responses such as volume depletion in the heart?

Answer 16

activation via baroreceptors increase heart rate and contractility and preload

Question 17

How does increasing preload in reducing HF?

Answer 17

Activating the RAAS( release of aldosterone which causes NA+ reabsorption and water increasing blood volume)

Question 18

How does hypertrophy aid in HF compensatory?

Answer 18

there is an increase of wall tension which causes hypertrophy this increases the contractile elements in the myocardium increasing the heart’s pumping force and helps to reduce the wall tension of the heart toward normal levels

Question 19

forward failure

Answer 19

insufficient cardiac pumping is manifested by poor CO( to the body)

Question 20

backward failure

Answer 20

congestion of blood behind the pumping chamber (to the lungs)

Question 21

What is left-sided heart failure must associated with?

Answer 21

left ventricular infarction and systemic hypertension

Question 22

What are the backward effects of left-sided heart failure?

Answer 22

pulmonary congestion and edema( accumulation of of blood is going to cause backflow of blood to the lungs increasing capillary hydrostatic pressure forcing blood in the interstitium) , dyspnea, orthopnea, paroxysmal nocturnal dyspnea and volume expansion from salt and water intake , cyanosis (fluid in the alveoli and interstitial fluid interferes with gas exchange and results in hypoxemia. hypoxemia is detected by arterial blood gas analysis) acute cardiogenic pulmonary edema (basilar crackling)

Question 23

Acute cardiogenic pulmonary edema

Answer 23

associated with left-sided heart failure with severe gas exchange. Si/SX: dyspnea, anxiety and bubbly crackles

Question 24

T/F Left ventricle failure eventually increases the workload of the right ventricle so it can also fail. So isolated right ventricle failure is rare

Answer 24

True

Question 25

Cor pulmonale

Answer 25

there is an increased pulmonary vascular resistance that increases afterload, this increase causes right ventricle hypertrophy which can lead to right ventricular failure

Question 26

What are the backward effects of right-sided heart failure?

Answer 26

heptamegaly (impedance to blood flow through the liver may cause hydrostatic pressure to build in the portal system leading to edema formation in the cavity (ascites)) Splenomegaly (the spleen enlarges because the pressure in the portal system is reflected back to the spleen and GI) anorexia and abdominal discomfort pain may be present, Jugular vein distention

Question 27

What are the forward effects of both the left and right side of heart failure?

Answer 27

fatigue, oliguria, increased heart rate, faint pulses, restlessness, confusion and anxiety

Question 28

What is the primary treatment for HF?

Answer 28

Improve CO via digitalis

Question 29

What are other ways to treat HF?

Answer 29

beta blockers- inhibit SNS activation
Improve contractility
ACE inhibitors
pacemakers