Heart failure I

Question 1

definition: heart failure

Answer 1

inability of the heart to pump sufficient blood to meet metabolic needs of body

Question 2

definition: myocardial failure

Answer 2

defective myocardial contraction

Question 3

definition: circulatory failure

Answer 3

condition in which an abnormality of some circulatory component (heart, vessels, blood volume) is responsible for inadequate CO

Question 4

what is the prevalence of HF worldwide? in the US?

Answer 4

worldwide - 23 million

US - 4.7 million

Question 5

what is the incidence of HF annually in the US?

Answer 5

3 million

Question 6

what is the neurohumoral mechanism of HF?

Answer 6

1. a series of compensatory adaptations normally preserve CO
2. activation of SNS (with concomitant suppression of PNS)
3. activation of renin angiotensin system

Question 7

what is the result of the neurohumoral mechanism of HF?

Answer 7

peripheral arterial constriction
sodium / water retention
activation of inflammatory mediators of cardiac remodeling

Question 8

what is the role of NE in HF?

Answer 8

increased circulating NE

decreased myocardial NE

Question 9

what do sustained high levels of angiotensin II cause?

Answer 9

organ fibrosis

enhanced NE release

Question 10

in HF, how do LV volume and SV relate? what is the significance?

Answer 10

LV volumes increase bu SV increases only slightly

Question 11

what is backward HF?

Answer 11

LV failure leads to backup into lungs - pulmonary edema

Question 12

what is forward HF? what is the result?

Answer 12

inadequate delivery of oxygen into arterial system (reduced CO)

results in decreased perfusion of vital organs with mental clouding, weakness, and sodium / water retention

Question 13

does true congestive heart failure deal with left or right HF? this owes to what process?

Answer 13

left

central venous congestion

Question 14

RV failure results in what type of congestion?

Answer 14

systemic

Question 15

what is the most common form of HF?

Answer 15

abnormal systolic function

Question 16

what are three features of systolic (LV) failure?

Answer 16

1. abnormal systolic function
2. high end diastolic ventricular volumes
3. poor perfusion, sodium and water retained

Question 17

what are three features of diastolic (LV) failure?

Answer 17

1. abnormal diastolic filling
2. high LV filling pressure
3. eventual pulmonary and systemic congestion

Question 18

what are the top three etiologies of HF?

Answer 18

1. ischemia / infarction
2. HTN
3. arrhythmias

Question 19

class I HF

Answer 19

no limitation

Question 20

class II HF

Answer 20

slight limitation of activity

ordinary activity causes symptoms - dyspnea, fatigue, palpitations, angina

Question 21

class III HF

Answer 21

marked limitation - less than normal activity precipitates symptoms

Question 22

class IV HF

Answer 22

symptoms at rest

Question 23

HF classification: no limitation

Answer 23

class I

Question 24

HF classification: slight limitation of activity, ordinary activity causes symptoms - dyspnea, fatigue, palpitations, angina

Answer 24

class II

Question 25

HF classification: marked limitation - less than normal activity precipitates symptoms

Answer 25

class III

Question 26

HF classification: symptoms at rest

Answer 26

class IV

Question 27

what is kussmaul’s sign? what is the cause?

Answer 27

paradoxical rise in JVP on inspiration

impaired filling of the RV due to either fluid in the pericardial space or a poorly compliant myocardium / pericardium

Question 28

what is the prognosis for HF in the US for men and women? what is the 5 yr survival for men and women?

Answer 28

men - 1.7 years
women - 3.2 years

men - 25%
women - 32%

Question 29

most people with HF die from what complications?

Answer 29

pump failure

tachyarrhythmias

Question 30

what are the etiologies of high-output HF?

Answer 30

anemia 
AV fistula 
hyperthyroidism 
beri-beri 
paget's disease of bone