Heart Failure – Part 2:Clinical Manifestations and Diagnosis

Question 1

3 major symptoms of Cardiac Failure

Answer 1

↓ Cardiac output

↑ Pulmonary venous pressure (Left-sided)

↑ Central venous pressure (Right-sided)

Question 2

↑ Central venous pressure (Right-sided) causes

Answer 2

edema

• symptoms of Cardiac Failure

Question 3

↑ Pulmonary venous pressure (Left-sided) causes

Answer 3

breathlessness

• symptoms of Cardiac Failure

Question 4

↓ Cardiac output causes

Answer 4

Symptoms of decreased organ perfusion

• symptoms of Cardiac Failure

Question 5

Symptoms of low flow

Answer 5

↓ cerebral perfusion
↓ muscle perfusion
↓ gut perfusion
↓ kidney perfusion

Question 6

↓ cerebral perfusion (low flow) causes

Answer 6

Sleepiness, confusion

Question 7

↓ muscle perfusion (low flow) causes

Answer 7

Fatigue, weakness

Question 8

↓ gut perfusion (low flow) causes

Answer 8

Anorexia, Wasting (cachexia)

Question 9

↓ kidney perfusion (low flow) causes

Answer 9

Reduced urine output

Progressive renal dysfunction

Question 10

Symptoms of ↑ left-sided pressure

Answer 10

↑ Pulmonary venous pressure=

Breathlessness (dyspnea)
Dyspnea on exertion
Orthopnea
Paroxysmal nocturnal dyspnea
Acute pulmonary edema

Question 11

Orthopnea or orthopnoea is shortness of breath (dyspnea) which occurs when _______

Answer 11

lying flat, immediate

Question 12

Delayed SOB, waking patients from sleep
Classically patient gets out of bed and ambulates to relieve symptoms
Relates to mobilization of edema from tissue through lymphatics back into blood stream

Answer 12

Paroxysmal nocturnal dyspnea (PND)

Question 13

Symptoms of ↑ right-sided pressure

Answer 13

↑ Central venous pressure (RV failure)= 
Peripheral swelling / dependent edema
Ascites
Hepatic congestion
Intestinal congestion (protein-losing enteropathy)

Question 14

Precipitating factors producing acute or worsening symptoms

Answer 14

**Increased circulating volume (preload)= Sodium load in diet

Increased pressure (afterload)

Worsened contractility (inotropy)

Arrhythmia (rate)

Increased metabolic demands

**Non-adherence with HF medications

Question 15

Paroxysmal nocturnal dyspnea (PND)

Answer 15

Delayed SOB, waking patients from sleep
Classically patient gets out of bed and ambulates to relieve symptoms
Relates to mobilization of edema from tissue through lymphatics back into blood stream

Question 16

Symptoms generally define the severity of the disease, ex?

Answer 16

Disease severity is one of the strongest predictors of death in heart failure.

Question 17

Symptoms are often determine therapy e.g.

Answer 17

more aggressive therapies are indicated for more advanced disease)

Question 18

Signs of low flow

Answer 18

Cool extremities
Tachycardia
Low pulse pressure (difference between systolic and diastolic pressure)

Question 19

Tachycardia in HF is

Answer 19

Compensate for low stroke volume

Question 20

Signs of ↑ left-sided pressure

Answer 20

Rales (pulmonary crackles)
Hypoxia
Tachypnea
Sitting bolt upright

Question 21

Signs of ↑ right-sided pressure

Answer 21

Edema
Follow gravity (legs, sacrum, scrotum)
Hepatic congestion / hepatomegaly
Jugular venous distention (JVD)

Question 22

S3 is thought to be caused by rapid expansion of the?

Answer 22

ventricular walls in early diastole

Question 23

S4 is caused by atria contracting forcefully in an effort to?

Answer 23

overcome an abnormally stiff or hypertrophic LV

Question 24

Co-existing conditions which predispose to HF

Answer 24

HEART DISEASE:
CARDIAC RISK DISORDERS:
ABSENCE OF NON-HF CAUSES OF DYSPNEA

Question 25

Differential diagnosis for HF Signs and Symptoms

Answer 25

``` Pulmonary disease Sleep apnea Obesity Deconditioning Anemia Renal failure Hepatic failure Venous stasis / lymphedema Depression ```

Question 26

Natriuretic Peptides (BNP)

Answer 26

B-type natriuretic is secreted by the myocardium in response to; Primary: ventricular stretch (measure of preload) Secondary: hyperadrenergic state, RAAS activation, ischemia

Question 27

Diagnostic use of BNP

Answer 27

Elevations are most often due to HF

Question 28

negative predictive value of BNP is more useful meaning

Answer 28

a low BNP makes HF unlikely as the cause of symptoms, + does not help when HF is already known

Question 29

EKG in HF

Answer 29

No direct diagnosis of HF

Question 30

Echocardiography Provides

Answer 30

``` LVEF (systolic function) Chamber size (dilation) LV wall thickness (hypertrophy) Measures of relaxation (diastology) Valvular anatomy and function Estimated filling pressures (LA, CVP) Estimated pulmonary pressures (pulmonary hypertension) ```

Question 31

catheter introduced thru veins &then “floated” through the r. heart to pulmonary a Has a balloon on the end of it to help blood flow carry it into the lungs The balloon also allows a branch of the pulmonary artery to be occluded so that the downstream pressure can be measured, which is equivalent to the ______________

Answer 31

(Procedure: Swan-Ganz catheter) left atrial pressure / left-sided filling pressure.