heart failure - essential

Question 1

what is HF

Answer 1

CLINICAL syndrome that results from any structural or functional impairment in the ability to pump blood forward

Question 2

what is impact of HF

Answer 2

• most rapidly rising CVD
• 20-30% mortality per year
• median survivial 2 years

Question 3

5 anatomical ways to classify HF

Answer 3

1. coronary arts.
   - MI, ischemic
2. myocardium
   - cardiomyopathies
3. endocardium
   - valvular disease
4. pericardium
   - constrictive percarditis
5. systemic disease
   - anemia, nutritional, metabolic

Question 4

steps to HF process

Answer 4

injury>early dysfunction>neurohormonal acvitation>

1. persisitent dysfunction
2. or normal function - rare

Question 5

3 phases of HF

Answer 5

1. persistent dysfunciton
   - meds
2. symptoms
   - meds/device
3. refractory/advanced
   - surg

Question 6

4 stages of HF

Answer 6

A -high risk, no Sx
B - structural disease, no Sx
C - symptoms
D - refractory sysmotoms

Question 7

what is cardiac output

Answer 7

stroke volume x HR

Question 8

3 parts of neurohormonal activation

Answer 8

1. RAAS activation
2. non-osmotic release of vasopressin
3. activation of SNS
   all give incr. HR, keep water

Question 9

what is remodelling

Answer 9

anatomic changes in the vent. that are initially adaptive but later become maladaptive
- due to neurohormonal changes

Question 10

2 types of remodelling

Answer 10

1. eccentric
   - large volume, thin wall
2. concnetric
   - thick wall, hihg pressure

Question 11

what is problem with remodelling

Answer 11

• unfavorable geometric chnages

- increasing circulating catecholamines

Question 12

what is systolic vs. diastolic LV dysfunction

Answer 12

• can co-exist
  1. diastolic - impaired filling, preserved ejection fraction
• normal LV size
• concentirc hypertrophy
• thick wall
  2. systolic - impaired contraction, reduced EF
• ## LV dilatation, eccentic hypertrophy

Question 13

what is seen in pressure volume loop in systolic failure

Answer 13

• rightward shift

- loss of ionotropy

Question 14

what is seen in pressure volume loop in diastolic failure

Answer 14

• leftward shift

- decreased compliance

Question 15

major causes of reduced EF HF

Answer 15

• CAD # 1
• HT
• viral

Question 16

major cause of reserved EF HF

Answer 16

• HT # 1

Question 17

***3 rules of R heart failure

Answer 17

1. whatever happens to the L can also happen to the R
2. most common cause of RV failure is LV failure
3. any condition causing increase RV afterload can cause RV failure

Question 18

2 major Sx types of HF

Answer 18

1. low forward output
   - fatigue
   - weakness
   - excercise intolerance
   - lightheaded
   - syncope
2. congestion
   - SOB
   - orthopnea
   - PND
   - peripheral edema

Question 19

4 functional classes of HF

Answer 19

1. no Sx
2. limited with normal activity
3. limited with less than normal activity
4. severly limited

Question 20

goal of Tx

Answer 20

reduce Sx and survival

- lifestyle can be major

Question 21

3 non pharma Tx

Answer 21

1. avoid salt
2. monitor weight daily
3. excercise

Question 22

2 drugs that make ppl feel better

Answer 22

1. diuretics

2. digoxin

Question 23

3 drugs that imprve survival

Answer 23

1. ACEis and ARBS
2. B -block
3. aldo antag
   - see notes for mech.

Question 24

2 times to Tx

Answer 24

1. all PT with LV dysfunction (

Question 25

3 Tx for advanced HF

Answer 25

1. shokcing
2. pacing
3. pumping

Question 26

what is goal of vent assist device

Answer 26

buy time until can get a transplant