Heart Failure

Question 1

whats heart failure

Answer 1

• inability of the heart to meet the demands of the body

Question 2

what enables the heart to work as an effective pump? in terms of input and output

Answer 2

• input; one way valves -output; functioning muscle and chamber size

Question 3

what does demand of heart mean?

Answer 3

• deliver a b volume carrying oxygen , glucose etc. that allows body tissues to function as required

Question 4

what does guideline sat heat failure is?

Answer 4

• clinical syndrome of reduced cardiac output, tissue hypo perfusion , increased pulmonary pressure and tissue congestion

Question 5

conditions that affect feature of the heart that c impaired cardiac function are?

Answer 5

• (one way) valves - functional muscle - chamber size

Question 6

aetiology of HF

Answer 6

• (most commonly) IHD (coronary heart disease) - myocardial dysfunction (through fibrosis and remodelling of the heart - ^BP (hyt.) (2nd most common) -Aortic stenosis - arrhythmia (how well the chambers fill)(HFpEF) - cardiomyopathies - pericardial diseases

Question 7

what are rare c of HF

Answer 7

• severe anaemia -sepsis - thyrotoxicosis (too much thyroid hormone) - d ^cardiac output ( heart cant deal w it even heart healthy )

Question 8

^BP

Answer 8

• increase after load -major risk factor for MI wc can c HFd fibrosis (v ability to contract ) ( HFrEF)

Question 9

how do we measure the ability of the heart to meet demands of the body

Answer 9

• CO = SV x HR

Question 10

ejection fraction

Answer 10

• SV/EDV x 100 (usually presented as %) (50-70% normal)

Question 11

what influences SV

Answer 11

• ^ preload ; pressure in ventricle before contracts (measure of b in ventricle STARLINGS LAW) -myocardial contractibility -negative influence ; after load (what heart pumps against ^BP/ stenosis ) TPR

Question 12

draw starling law graph

Answer 12

image

Question 13

what increases contractibility of the heart

Answer 13

SYMP activation (also increases HR)

Question 14

why is CO reduced in heart failure

Answer 14

• v preload (d imparted filling of the heart when relaxed c v chamber size?) - v myocardial contractibility ( d failure with contractibility ) -^ after load (d stenosis + ^BP)

Question 15

what 2 c of heart failure

Answer 15

• filling issue -contraction issue

Question 16

what c filling issues

Answer 16

-ventricular volume/ capacity of b reduced - chamber stiff/ not relaxing enough - ventricular walls thicken (hypertrophied as they remodel) -EDV v d space in ventricle filling b is reduced

Question 17

what c contractibility issues

Answer 17

-poor ventricular contraction no issue with space -systolic issue - muscle wall thin/fibrosed - chambers enlarged (overstretched sarcomere) -abnormal or uncoordinated myocardial contraction

Question 18

how to classify HF

Answer 18

• HFrEF (systolic, contraction issue) (<50-70%EF) -HFpEF (diastolic , filling problem) (no contraction issue so fraction isn’t effected bu the numbers will be reduced)

Question 19

how measure EF

Answer 19

-echo (b can see shape and size of chambers, + valves)

Question 20

classifying HF according to ventricles

Answer 20

• LV = (most common bc additional RHF) - biventricular HF = congestive HF - chronic lung disease = RHF ( d areas of …)

Question 21

starlings curve of HF

Answer 21

• in HFpEF = very little increase in CO, wc should increase in normal heart if you increase filling , eventually increasing b filling c v CO - resulting pulmonary. congestion

Question 22

v CO does what?

Answer 22

• damage ventricle - v Vcontraction -v SV -r CO - activation of neurohormonal system

Question 23

neuro-hormonal system

Answer 23

• baroreceptors (carotid sinus) detect the v BP - c ^ sympathetic drive ( ^ HR, ^ TPR -= ^ afterload = ^ CO - heart is alrady struggling so ^ damage than good , and ^ demand b ^ 02 required - also activates the RAAS b kidney sense it as result of v renal perfusion - c brain = corticotropin , ADH - c adrenal = aldosterone -c bv = vasoconstriction - c kidney = Na=reab. -c ^ preload and ^ afterload

Question 24

clinical symptoms

Answer 24

• fatigue/ lethargy - breathlessness ( when lying flat d RHF) - peripheral oedema (RHF) - pulmonary oedema (LHF)

Question 25

why does oedema occur

Answer 25

• d ^ VP = ^ capillaries so blood moves out the capilarry into interstitial space = oedema - LHF - back load of blood from v -> A -> backs up into pulmonary system (pulmonary cant deal with too much ^ hydrostatic p) and so b moves into the pulmonary interstitial space c pulmonary oedema [ RHF; RV->rA) -listen to this again

Question 26

raised jugular venous pressure

Answer 26

• indication of the RHF

Question 27

similaries bw RHF and LHF

Answer 27

image of tabel

Question 28

whats seen on a xray of congestive heart failure

Answer 28

upper lobe diversion (dilated pulomary veins)

cardiomegaly

pleural effusion

alveolar oedema

Question 29

pain radiating to between the shoulder blades

Answer 29

aoric dissection