HFpEF

Question 1

what EF counts as PRESERVED

Answer 1

> 50%

Question 2

where do we find objective evidence of HFpEF

Answer 2

elevated LV filling pressure on

ECHO or Cardiac Cath

Question 3

what population is MC?`

Answer 3

elderly patient w/ asymptomatic HTN

mc in female patients

Question 4

HFpEF progression to rEF

Answer 4

this is NOT present in absence of coronary dz/MI

only w/ MI or coronary dz will this happen

Question 5

“options” to cause HFpEF

Answer 5

1. diastolic dysfunciton
2. LV remodeling
3. Abnormal Ventricular -Arterial dysfunction
4. R sided HF
5. Chronotrophic Incompetence
6. CAD
7. Comorbidities

Question 6

Diastolic dysfunction

Answer 6

shifting up to left in pressure volume = small increase in volume causes MAJOR change in BP

results in increased wall thickness and fibrosis and inability to relax

Question 7

LV ventricular remodeling

Answer 7

concentric remodeling (increased thickness and mass) due to increased systolic wall stress

parallel sarcomere addition

causes fibrosis, CHF, myocardial dysfunction

Question 8

LV wall remodeling leaves which layer especially uneatable to ischemia

Answer 8

SUBENDOCARDIUM

Question 9

subendocardial ischemia causes ___ dysfunction

Answer 9

BOTH systolic and diastolic

systolic: myocardial stunning, hibernation, and death
diastolic: concentric hypertrophy and fibrotic changes

Question 10

healthy AV coupling

Answer 10

arterial and ventricular elasticity are matched to maintain efficiency

Question 11

abnormal av coupling

Answer 11

increasing age causes ventricular stiffness that causes decreased contractility

susceptible to: HF, BP lability, decreased exercise tolerance

results in HIGH pulse pressure so susceptible to change in blood volume

Question 12

right HF

Answer 12

hypertrophy and fibrotic stiffness cause backing up into LA and eventually pulmonary circuit

Question 13

pulmonary HTN diagnostic criteria

Answer 13

mPAP > 255 mmHg

PCWP >15 mmHG

Question 14

chronotropic incompetence

Answer 14

inability to increase HR during exertion which results in exercise intolerance

caused By resitrictive cardiomyopathy, severe LV hypertrophy and CAD

Question 15

CAD

Answer 15

50% of pts concomitant

MI, ongoing ischemia or chronic dz causes hypertrophy and hyperdynamic functioning in healthy areas

calcium sequestration in diastole - impaired filling and relaxation

Question 16

risk factors for HFpEF

Answer 16

Age
HTN
sleep apnea
comorbidities

Question 17

age and pEF

Answer 17

almost all its w/ are elderly

age decreases diastolic filling rate causing atrial overload and pulmonary HTN

also causes AV stiffness which leads to decreased ability to accommodate positional changes and exercise

Question 18

HTN and HFpEF

Answer 18

MOST IMPORTANT

causes LV hypertrophy = poor coronary flow and impaired relaxation

risk factor for CAD which complicates HFpEF (chronic ischemia = angina)

Question 19

sleep apnea

Answer 19

increases LV hypertrophy and pulmonary HTN

increased fatigue = decreased exercise tolerance

Question 20

signs and symptoms of pEF

Answer 20

exersize intolerance, JVD, s4

rales/wheezing, PND/orthopnea, edema/anasarca.ascities

Question 21

exercise intolerance

Answer 21

decreased lung compliance due to increased pulmonary pressure

increased LV diastolic pressure limits subendocardial blood flow which increased demands = decreased diastolic fxn

blunted cardiac output

worsening myocardial perfusion

Question 22

diagnostic studies in pEF

Answer 22

echocardiogram 
proBNP
stress test (exercise or pharm) 
stress echo
cardiac cath
cardiac MRI