Introduction

Question 1

Definition of Heart Failure

Answer 1

The heart is unable to pump blood at a rate sufficient to meet the metabolic demands of the body due to impaired ventricular filling or ejecting of blood.

Question 2

Risk Factors for Development

Answer 2

MI, HTN, DM, Obesity, Cigarette Smoking

Question 3

HFrEF

Answer 3

• decreased contractility
• decreased LVEF ( less than or equal to 40%)
• many times have an increase in left ventricular size (cardiomyopathy)

Question 4

HFpEF

Answer 4

• restrictions in ventricular filling
• generally have preserved EF ( LVEF of greater than or equal to 50%)
• ventricles can’t get enough blood from venous system
• generally unable to maintain SV

Question 5

Factors that precipitate or worsen HF

Answer 5

• non-compliance with therapy or diet
• Cardiac events (MI, arrhythmias)
• Afib
• Pulmonary infections
• Anemia
• Drugs

Question 6

NYHA Class I (mild)

Answer 6

• No limitation of physical activity

- ordinary physical activity does not cause undue fatigue, palpitation, or dyspnea

Question 7

NYHA Class II (mild)

Answer 7

• Slight limitation of physical activity

- Comfortable at rest, but ordinary physical activity results in fatigue, palpitation or dyspnea

Question 8

NYHA Class III (moderate)

Answer 8

• Marked limitation of physical activity

- Comfortable at rest, but less than ordinary activity causes fatigue, palpitation, or dyspnea

Question 9

NYHA Class IV (severe)

Answer 9

• Unable to carry out any physical activity without discomfort
• Symptoms of cardiac insufficiency at rest
• If any physical activity is undertaken, discomfort is increased

Question 10

Favorable Effects of Adrenergic System

Answer 10

• increased heart rate
• improved cardiac output
• increased contractility
• maintenance of perfusion pressure

Question 11

Detrimental Effects of Adrenergic System

Answer 11

• Progressive LV remodeling
• LV hypertrophy failure
• atrophy
• increased SVR = Increased afterload
• Na & H2O retention
• facilitation of renin release

Question 12

Detrimental effects of RAAS

Answer 12

occur at the AT1 receptor: arterial vasoconstriction, cell growth (hypertrophy)

Question 13

Arginine Vasopressin (upregulated)

Answer 13

• causes hyponatremia in HF patients

- acts on kidney to reduce free H2O clearance

Question 14

Subjective Signs of HF

Answer 14

• dyspnea (most common)
• orthopnea
• paroxysmal nocturnal dyspnea
• fatigue
• exercise intolerance
• fluid overload (pulmonary congestion & peripheral edema)
• Hemoptysis (coughing up blood)
• Abdominal pain
• Anorexia
• Nausea
• Bloating
• Poor appetite, early satiety

Question 15

Objective Signs of HF

Answer 15

• Pulmonary rales & edema
• S3 gallop
• cool extremities
• Pleural effusion
• Tachycardia
• Cheyne-Stoke Respiration
• Cardiomegaly
• Jugular Venous Distension
• Hepatojugular Reflex
• Hepatomegaly