Heart Failure

Question 1

Left side Heart Failure

Answer 1

1. D/t systolic or diastolic dysfunction
   
   1. Symptoms of low cardiac output & elevated pulmonary venous pressure:
      
      1. Congestion
      2. Dyspnea, orthopnea, paroxysmal nocturnal dyspnea, rest dyspnea
      3. Chronic nonproductive cough
      4. Nocturia
      5. Fatigue
      6. Exercise intolerance

Question 2

Right Sided Heart Failure

Answer 2

1. Right ventricle failure
   
   1. RV failure typically secondary to LV failure
   2. Symptoms of fluid overload
      
      1. Edema
      2. Hepatic congestion
      3. Loss of appetite

Question 3

heart failure in general

Answer 3

1. 75% of existing and new cases affect > 65yo
2. 75% of heart failure patients have antecedent HTN
3. Prevalence:
   
   1. < 60yo = < 1%
   2. > 80yo = 10%
   3. Systolic heart failure
      
      1. Most common cause: CAD w/ resulting MI –> ischemic cardiomyopathy
      2. Systemic HTN

Question 4

Diastolic cardiac dysfunction

Answer 4

Diastolic cardiac dysfunction

Assoc. w/ aging, myocardial stiffening, & LVH (result of HTN)

Question 5

staging of heart failure

Answer 5

1. StagingStage A – asymptomatic
   
   1. Patients at risk for developing HF (e.g. HTN patients)
2. Stage B – symptomatic w/ mild activity
   
   1. Structural heart disease but no current or previous symptoms of HF
   2. E.g. previous MI, other causes of reduced systolic function, LVH, or asymptomatic valvular disease
3. Stage C – symptomatic w/ mild activity
   
   1. Clinical HF
4. Stage D – symptomatic at rest
   
   1. Refractory to usual therapies

Question 6

Cardinal cardiac examination signs

Parasternal lift

Answer 6

Cardinal cardiac examination signs

Parasternal lift = pulmonary HTN

Enlarged & sustained LV impulse = LV dilation & hypertrophy

Diminished 1st heart sound = impaired contractility

S3 gallop originating in LV and sometimes in RV

S4 = diastolic HF

Tricuspid and secondary mitral regurgitation = dilated ventricles

Question 7

Cardinal cardiac examination signs

Enlarged & sustained LV impulse =

Answer 7

Cardinal cardiac examination signs

Parasternal lift = pulmonary HTN

Enlarged & sustained LV impulse = LV dilation & hypertrophy

Diminished 1st heart sound = impaired contractility

S3 gallop originating in LV and sometimes in RV

S4 = diastolic HF

Tricuspid and secondary mitral regurgitation = dilated ventricles

Question 8

Cardinal cardiac examination signs

Diminished 1st heart sound =

Answer 8

Cardinal cardiac examination signs

Parasternal lift = pulmonary HTN

Enlarged & sustained LV impulse = LV dilation & hypertrophy

Diminished 1st heart sound = impaired contractility

S3 gallop originating in LV and sometimes in RV

S4 = diastolic HF

Tricuspid and secondary mitral regurgitation = dilated ventricles

Question 9

Cardinal cardiac examination signs

S3 gallop

Answer 9

Cardinal cardiac examination signs

Parasternal lift = pulmonary HTN

Enlarged & sustained LV impulse = LV dilation & hypertrophy

Diminished 1st heart sound = impaired contractility

S3 gallop originating in LV and sometimes in RV

S4 = diastolic HF

Tricuspid and secondary mitral regurgitation = dilated ventricles

Question 10

Cardinal cardiac examination signs

S4 =

Answer 10

Cardinal cardiac examination signs

Parasternal lift = pulmonary HTN

Enlarged & sustained LV impulse = LV dilation & hypertrophy

Diminished 1st heart sound = impaired contractility

S3 gallop originating in LV and sometimes in RV

S4 = diastolic HF

Tricuspid and secondary mitral regurgitation = dilated ventricles

Question 11

Cardinal cardiac examination signs

Tricuspid and secondary mitral regurgitation =

Answer 11

Cardinal cardiac examination signs

Parasternal lift = pulmonary HTN

Enlarged & sustained LV impulse = LV dilation & hypertrophy

Diminished 1st heart sound = impaired contractility

S3 gallop originating in LV and sometimes in RV

S4 = diastolic HF

Tricuspid and secondary mitral regurgitation = dilated ventricles