Heart Failure I - Pathophysiology

Question 1

T or F: HF is largely a disease of the Aged

Answer 1

True, median age is 75

Question 2

General definition of HF

Answer 2

The inability of the heart pump to pump blood forward at a sufficient rate to meet the metabolic demand of the body (forward failure), or the ability to do so only if the cardiac filling pressures are abnormally high (backward failure)

Question 3

Key requirement component of HF

Answer 3

Poor forward blood flow (decreased CO)

Question 4

T or F: Backward buildup of pressure is almost always present as well

Answer 4

Ture, results in congestion (increased filling pressure)

Question 5

What relationship states that the more the LV is filled, the more it will contract

Answer 5

Frank-Starling’s law

Question 6

Increased Preload for the same inotropic states results in what?

Answer 6

Increased SV (this, increased CO)

Question 7

What are the determinant agents of inotropy?

Answer 7

• Catecholaminergic/adrenergic

- Calcium

Question 8

T or F: Inotropy produces increased SV for the same level of preload

Answer 8

Ture

Question 9

What are the major types of HF

Answer 9

• Systolic and Diastolic

- Left sided vs. Right sided

Question 10

What are the hallmarks of systolic HF?

Answer 10

• Decreased ejection fraction (HFeEF, LVSD)
• Ventricular enlargement (Dilated Cardiomyopathy)
• A problem with the squeeze

Question 11

What measures are decreased in systolic HF?

Answer 11

Loss of inotropy= low SV and lower generated systolic BP

Question 12

List Primary causes of systolic HF

Answer 12

• Direct destruction of heart muscle cells (MI)
• Overstressed heart muscle
• Volume overloaded heart muscle

Question 13

What are the hallmarks of Diastolic HF?

Answer 13

• Normal ejection fraction (HFpEF)
• Ventricular wall thickening (LVH)
• Impaired filling

Question 14

What measures are different in diastolic HF?

Answer 14

lower SV

Question 15

Primary causes of diastolic HF?

Answer 15

• High afterload/pressure overload
• Myocardial thickening/fibrosis
• External compression

Question 16

Normal systemic vs pulmonary bp

Answer 16

• Systemic: 120/80 mmHg

- Pulmonary: 22/10 mmHg

Question 17

T or F: R ventricle does less work

Answer 17

True

Question 18

Consequences of R Sided HF

Answer 18

• Decreased circulating blood flow (forward RV HF)

- increased venous pressures (Backwards RV HF)

Question 19

Primary causes of R sided HF

Answer 19

• L HF
• Lung disease/pulmonary HTN/RV pressure overload (car pulmonale when primary lung disease causes HF)
• RV volume overload
• Damage to the RV myocardium

Question 20

T or F: HF forms clinically coexist

Answer 20

True, systolic dysfunction is typically accompanied by diastolic dysfunction and vice verse

Question 21

What is the underlying problem with HF?

Answer 21

reduced CO

Question 22

List the compensatory responses to HF

Answer 22

• neurohumoral activation
• Frank-Starling (increased preload)
• Ventricular hypertrophy and dilation

Question 23

What 2 regulation systems are activated by HF?

Answer 23

• Adrenergic activation

- Renin-angiotensin system