HF Pathology

Question 1

Heart Failure

Answer 1

Ability of heart to pump blood is decreased leading to decrease CO

Question 2

CO =

Answer 2

CO=SV x HR
CO=4-8 L/min

Question 3

5 Factors affecting CO

Answer 3

Cardiac contractibility
Heart rate
Preload
Afterload
Blood volume

Question 4

Chronic cause of HF

Answer 4

CAD
Cardiomyopathy
HTN
Pulmonary disease
Valvular Disease

Question 5

Acute cause of HF

Answer 5

Acute MI
Myocarditis
Hypertensive crisis
Rupture of papillary muscle
Dysrhythmias

Question 6

Ejection Fraction

Answer 6

% of end-diastolic blood volume that is ejected during systole
Normal EF is greater than 60%

Question 7

HF with reduced EF

Answer 7

Systolic dysfunction
Most common form of HF
LV cannot contract strongly enough to pump blood into aorta
EF usually less than 40

Question 8

HF with preserved EF

Answer 8

Diastolic Dysfunction
Inability of ventricles to relax and fill during diastole
Decrease filling = Decrease SV
High filling pressure due to poorly compliant ventricles for example too small, too stiff to relax and fill completely
Ventricular hypertrophy common

Question 9

Mixed HF

Answer 9

Both systolic and diastolic dysfunction

Question 10

HF Compensatory Mechanisms

Answer 10

1) SNS activation
2)Neuro-Hormonal Response
3) Ventricular Dilation
4) Ventricular Hypertrophy

Question 11

SNS Activation

Answer 11

increase HR, contractility, peripheral vasoconstriction
They do increase CO but also increase workload

Question 12

Neuro-Hormonal Response (RAAS)

Answer 12

Na/water retention, increase peripheral vasoconstriction, ADH cause water retention

Question 13

Ventricular Dilation:

Answer 13

Enlargement of the heart chambers usually LV, muscle fibres of heart stretch
Initially good, but over time stretch too far and decrease CO

Question 14

Ventricular Hypertrophy

Answer 14

Increase muscle mass and ventricular wall thickness

Question 15

Acute HF

Answer 15

Acute HF are often due to pulmonary edema

Question 16

Chronic HF

Answer 16

Long term HTN, less and less tolerance, SOB after walking

Question 17

Left sided HF

Answer 17

Due to decrease CO or pulmonary congestion

Question 18

Right sided HF

Answer 18

Due to increase systemic venous congestion

Question 19

Biventricular failure

Answer 19

Failure of one pump will eventually cause other pump to fail

Question 20

General symptom of Right sided HF

Answer 20

Weight gain
Increase BP

Question 21

H2T for Right sided HF

Answer 21

Jugular vein distension
Swollen hands and fingers
Anorexia and nausea
Distended abdomen
Enlarged liver and spleen
Polyuria at night
Dependent edema

Question 22

H2T for Left sided HF

Answer 22

• Fatigue
• Confusion, restlessness
• Tachycardia
• Angina
  Oliguria
  Pallor, weak
• Cool extremity

Question 23

Pulmonary Congestion

Answer 23

Cough
Dyspnea
Crackles/Wheezes
Fronthy-pink tinged sputum

Question 24

Orthopnea

Answer 24

SOB with lying down, fluid return to central circulation when lying flat

Question 25

Paroxysmal Nocturnal Dyspnea

Answer 25

Sudden onset on SOB at night when sleeping

Question 26

Dysrhythmias

Answer 26

enlarged heart chambers can cause changes in electrical pathway, Afib, ventricular arrythmias

Question 27

Left Ventricular Thrombus

Answer 27

Enlargement of LV and decrease CO

Question 28

Hepatomegaly

Answer 28

Hepatic congestion can lead to impaired liver function

Question 29

Renal Failure

Answer 29

Decrease perfusion can lead to renal insufficiency or failure