Intro to HF and Ventricular Dysfunction

Question 1

HF with reduced EF

Answer 1

LVEF < 40%
Often have dilated LV (volume overload)
Frequently co-exists with diastolic dysfunction
Has been studied a lot and has good evidence for treatments, etc
Thinning of LV walls, decreased systolic function, and enlarged LV volume

Question 2

HF with preserved EF

Answer 2

LVEF > 40-50%
Often have increased wall thickness associated with impaired LV filling/suction (diastolic dysfunction)
May have mild systolic dysfunction
Pressure overload (concentric hypertrophy)
Elevated BNP
50% of HF
Similar outcomes to patients with HFrEF
Less studied

Question 3

4 classes of NYHA classification

Answer 3

1. No symptoms with regular exercise
2. Ordinary activity = mild symptoms. None at rest
3. Symptoms with any activity. Only comfortable at rest
4. Symptoms at rest

Question 4

4 causes of decreased SV

Answer 4

Low LV preload
Impaired LV contractility
Back flow
High afterload

Question 5

Impaired renal perfusion from decreased forward flow results in activation of what 2 systems?

Answer 5

RAAS

SNS

Question 6

4 unwanted effects of RAAS activation

Answer 6

Sodium and fluid retention
Vasoconstriction
Myocardial fibrosis
SNS activation

Question 7

3 unwanted effects of SNS activation

Answer 7

Increased HR
Increased contractility
Vasoconstriction

Question 8

4 beneficial effects of ANP and BNP

Answer 8

Natriuresis/diuresis
Vasodilation
Anti-hypertrophy/anti-fibrosis
Inhibition of sympathetic NS

Question 9

Symptoms of HF

Answer 9

Fatigue and lethargy
Cool extremities
Confusion
Dyspnea
Angina
Swelling and bloating