Heart Failure

Question 1

Concentric Hypertrophy

Answer 1

Htn or aortic stenosis are the most common causes

New sarcomeres are parallel to long axes of myocytes

Results in increased wall thickness and a normal to reduced cavity diameter

Question 2

Volume overload hypertrophy

Answer 2

Due to mitral or Aortic valve regurgitation

New sarcomers assemble in series with existing

Results in dilation with increase ventricular diameter

Question 3

Left ventricular hypertrophy

Answer 3

Risk for sudden cardiac death

S wave > 30 mm in V2 and V3

Question 4

Physiologic hypertrophy

Answer 4

Due to aerobic exercise

Increased capillary density unlike other hypertrophied

Question 5

Systolic dysfunction

Answer 5

Insufficient cardiac output, low EF

Due to progressive deterioration of contractile function (ischemic heart disease, htn, dilated cardiomyopathy)

Question 6

Diastolic Dysfunction

Answer 6

Decrease stroke volume or inability to respond to increased demand

Due to failure to relax, expand, and fill (Massive left ventricular hypertrophy, myocardial fibrosis, constrictive pericarditis)

Question 7

Left-sided heart failure

Answer 7

Progressive congestion of blood within pulmonary circulation

Diminished peripheral blood flow

Question 8

Left-sided HF morphology

Answer 8

S3 heart sound indicated increased blood volume in the ventricle and/or stiffening of ventricle

Secondary enlargement of left atrium- atrial fibrillation

Pulmonary congestion and edema (Interstitial transudate causing Kerley B lines on X-ray)

Reduced renal perfusion (activated renin-ang-also says= retain Na and water= increase interstitial fluid and blood volume= worsen pulmonary edema)

Hypoxia encephalopathy

Question 9

Left-sided HF clinical

Answer 9

Cough dyspnea
Orthopnea
Paroxysmal nocturnal dyspnea

Question 10

Right-sided HF

Answer 10

Most common cause:left sided HF

Pure right-sided failure is uncommon and caused by disorders of pulmonary vasculature

Question 11

Right sided HF morphology

Answer 11

congestive hepatomegaly
Chronic passive congestion
Congestion around central veins shows red-brown ventriloquist discoloration and paler peripheral regions
Elevated pressure of portal vein (chronic edema of bowel wall)

Congestion of kidneys= greater fluid retention than in L-sided failure

Peripheral edema