Heart Failure

Question 1

What is heart failure?

Answer 1

Cardiac function is insufficient to pump blood at the rate required by tissues

Question 2

What is the ultimate cause of heart failure

Answer 2

Myocardial tissue failure

Question 3

What are the 3 characteristics of heart failure?

Answer 3

Reduced exercise tolerance

High incidence of ventricular arrhythmias

Shortened life expectancy

Question 4

What are some of the main causes of heart failure?

Answer 4

CAD

HTN

Dilated cardiomyopathies

Valvular disease (stenosis/regurg cause bad filling or emptying)

Myocarditis (infection)

Question 5

What is a normal ejection fraction?

Answer 5

More than 50%

Question 6

What kind of ejection fraction do peopel with heart failure have?

Answer 6

<40%

Question 7

Why do the ventricles dilate in heart failure?

Answer 7

A bigger volume of blood will help the heart move up the frank starling curve, so the body tries to exploit this by making the ventricles bigger

Question 8

What happens to resting stroke volume in heart filaure?

Answer 8

Decreases

Duh

Question 9

What happens to cardiac index in heart failure?

Answer 9

Reduces. Pt can no longer sustain enough CO to do their normal activities.

Question 10

What happens to contractility in heart failure?

Answer 10

It is deficient. The person can no longer respond efficiently to increases in preload (EDV)

Question 11

What are some of the cellular causes of heart failure?

Answer 11

Impaired calcium usage

Changes in ATP production/usage

Question 12

What is diastolic heart filaure?

Answer 12

Impaired filling

Impaired ventricular hypertrophy

Question 13

What usually causes right-sided heart failure?

Answer 13

Left sided heart failure

Question 14

What is systolic heart failure?

Answer 14

Diminished capacity to eject blood due to loss of contractility or high afterloads (HTN, aortic stenosis)

Question 15

What are the causes of impaired contractility?

Answer 15

Myocardial infarction

Transient myocardial ischemia

Chronic volume overload (mitral/aortic regurg)

Dilated cardiomyopathy

Question 16

What kinds of things can cause diastolic dysfunction?

Answer 16

1. Impaired ventricular relaxation- LV hypertrophy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, transient ischemia
2. Obstruction of LV filling- mitral stenosis, cardiac tamponade

Question 17

In left sided heart failure, what happens to the pressures in the L atrium and the pulmonary vasculature?

Answer 17

Pressures increase due to the activity of the right heart

Question 18

Can Left sided heart failure cause pulmonary edema?

Answer 18

Yes

Question 19

Is it hard to overload the right side of the heart>?

Answer 19

No, it is a low-pressure system and is easy to overload

Question 20

Is pulmonary hypertension always caused by left heart failure?

Answer 20

No it can be caused by poor lung function, which then causes R sided heart failure (cor pulmonale)*****

Question 21

What is jugular vein distention caused by?

Answer 21

Right sided heart failure

Question 22

Why would right sided heart failure cause peripheral edema?

Answer 22

Rise in venous pressures increases capillary pressures, which favors filtration!!!!!!!!!!***

Question 23

What are some of the compensatory mechanisms for heart failure?

Answer 23

Frank starling mechanisms (increased ESV)

Ventricular remodeling

Neurohormonal activation (adrenaline, renin-angiotensin, ADH/vasopressin)

Question 24

What are the two types of ventricular hypertrophy?

Answer 24

Concentric hypertrophy

Eccentric hypertrophy

Question 25

What causes concentric hypertrophy

Answer 25

Wall gets thicker due to pressure* overloads like stenosis or HTN

Question 26

What happens with concentric hypertrophy?

Answer 26

Parallel addition of new myofibrils causes increase in wall thickness

Question 27

What effect does concentric hypertrophy have on compliance?

Answer 27

Decreased compliance

Which can then cause diastolic problems

Question 28

What causes eccentric hypertrophy?

Answer 28

Volume overloads

Question 29

What happens with eccentric hypertrophy?

Answer 29

Ventricle becomes dilated due to the series addition of new sarcomeres

Question 30

What causes eccentric hypertrophy?

Answer 30

Ventricle becomes dilated due to valve regurgitation, transfusion overload, or increases in diastolic pressure

(Anything that causes a volume overload)

Question 31

Does the wall get thicker in eccentric hypertrophy?

Answer 31

No, it remains normal. The ventricle just dilates

Question 32

What neurohormones are released in response to heart failure?

Answer 32

Angiotensin II- vasoconstriction & more blood volume

ADH/Vasopressin-more blood volume

(All of these things may be helpful in the short term to increase venous return and increase stroke volume, but they ultimately lead to peripheral edema and pulmonary congestion)****

Question 33

What are the main goals of pharamcotherapy for heart failure?

Answer 33

Reduce work load

Reduce edema

Enhance contractility

Question 34

What effect does Digoxin have to treat heart failure?

Answer 34

Increases contractility

Question 35

What effect do loop diuretics have to treat heart failure?

Answer 35

Reduce edema

Reduce blood volume

Question 36

What effect do vasodilators have to treat heart failure?

Answer 36

They reduce preload and afterload

Question 37

What do ACE inhibitors (Captopril, Enalapril) do?

Answer 37

Inhibit the formation of angiotensin II which decreases preload and afterload and also reduces sodium retention by inhibiting ADH release

Question 38

Are beta blocker effective for heart failure?

Answer 38

Even though they’re usually used to reduce the contractility of the heart for HTN, they may be appropriate