Heart Failure

Question 1

___ is a clinical syndrome characterized by signs and symptoms associated with high intracardiac pressures and decreased cardiac output

Answer 1

Heart Failure

Question 2

___ is the abrupt onset of symptoms severe enough to merit hospitalization

Answer 2

Acute decompensated heart failure

Question 3

___is released by the ventricle when under wall stress in attempts to dilate and decrease ventricular pressure

Answer 3

BNP

Question 4

Differentiate the primary problem between systolic and diastolic heart failure

Answer 4

Systolic: ejection problem, dilated chamber; can fill OK

Diastolic: filling problem, hypertrophied chamber or septum; can eject OK

Question 5

What are some signs and symptoms of Systolic HF

Answer 5

• dilated LV
• PMI shifted to the left
• Valvular insufficiency (dilation causes MV insufficiency)
• EF < 40%
• Pulmonary edema due to poor ventricular emptying
• S3
• BP normal or low
• BNP elevated

Question 6

What are some signs and symptoms of diastolic HF?

Answer 6

• Normal ventricular size
• Thick ventricular walls and/or thick septum
• Normal contractile function
• Normal EF
• Pulmonary edema dur to high ventricular pressure
• S4 with HTN
• BP often high
• BNP elevated

Question 7

What drugs are contraindicated with SHF?

Answer 7

Negative inotropes (CCB and in acute phase, BB)

Question 8

What drugs are contraindicated with DHF?

Answer 8

• Positive inotropes
• Dehydration further worsens filling
• Tachyarrhythmias decrease filling time and worsens symptoms

Question 9

What is the treatment for SHF?

Answer 9

Beta Blockers
ACEI/ARB
Diuretics 
Dilators 
Aldosterone antagonists 
Positive inotropes

Question 10

What is the treatment for DHF?

Answer 10

BB
ACEI/ARB
CCB
Diuretics (low dose)
Aldosterone antagonists

Question 11

What cardiomyopathy types do you see in SHF?

Answer 11

• Dilated results in systolic HF

- Dilated may result in mitral insufficiency as left ventricular walls enlarges

Question 12

What cardiomyopathy types do you see in DHF?

Answer 12

• idiopathic hypertrophic subaortic stenosis (IHSS)
• Hypertrophic cardiomyopathy
• Hypertrophic obstructive cardiomyopathy

Question 13

NYHA HF Class:
Ordinary activity does not cause fatigue, dyspnea, palpitation, or anginal pain. There is no limitation of physical activity. Extraordinary activity results in HF sx

Answer 13

Class 1

Question 14

NYHA HF Class:
Comfortable at rest, but ordinary physical activity results in HF sx. There is some limitation of physical activity. Ordinary activity results in HF sx

Answer 14

Class 2

Question 15

NYHA HF Class:
Comfortable at rest. but less than ordinary activity causes HF sx. There is marked limitation of physical activity. Minimal activity results in HF sx

Answer 15

Class 3

Question 16

NYHA HF Class:
Sx of HF at occur at rest. If any physical activity is attempted, discomfort is increased. There is severe limitation of physical activity. Remaining at rest results in HF sx

Answer 16

Class 4

Question 17

Patients in class 2 - 4 of the NYHA HF classes are candidates for a ___.

Answer 17

ICD

Question 18

Dilated Cardiomyopathy is a ___ dysfunction and symptoms are similar to ___.

Answer 18

systolic ; systolic HF

Question 19

Hypertrophic cardiomyopathy is a ___ dysfunction and symptoms are similar to ___.

Answer 19

diastolic ; diastolic HF