Introduction and Pathophysiology of Heart Failure

Question 1

• Failure of the circulatory system
• 1) to provide adequate forward cardiac
output
• Or
• 2) to do so without operating at elevated
filling pressures

Question 2

JVP estimates the pressure of the ___ atrium

Answer 2

of the right atrium, which very indirectly estimates the preload of the left ventricle.

Question 3

right heart failure signs

Answer 3

elevated JVP

ascities

peripheral edema

weight gain

abdominal bloating/satiety

leg swelling

Question 4

pulmonary hypertension heart failure signs

Answer 4

parasternal lift

palpable P2

loud P2

fatigue

dyspnea

Question 5

left heart failure/high lest sided pressures signs

Answer 5

hypoxia, tachypnea, inspiratory crackles, S3

dypsnea, orthopnea, PND

Question 6

what does S3 mean

Answer 6

rapid ventricular overfilling.

• could be due to higher preloads because of reduced EF compensation resulting in ventricular dilation
• could be due to ventricular hypertrophy causing normal volumes to still be “overfilling”

Question 7

“Congestive” Heart Failure Typically Refers to A ___ Sided Problem- Traditionally A Problem Of LV Systolic Function (Heart Failure with Reduced___ ____)

Answer 7

“Congestive” Heart Failure Typically Refers to A LEFT Sided Problem- Traditionally A Problem Of LV Systolic Function (Heart Failure with Reduced EJECTION FRACTION)

• but it can also be heart failure with preserved ejection fraction

Question 8

DDX for congestive heart failure (hint think of “left” parts of the heart that can go bad) congestive = left

Answer 8

1. left ventricle failures: HFREF or HFPEF
2. Mitral valve failure: MR or MS
3. Aortic valve: AS or AI
4. Aorta: Coarctation, severe hypertension
5. pericardial construction– heart muscle is normal but pericardial stiffness causes heart unable to expaand

Question 10

DDx of isolated right heart failure

Answer 10

• primary right ventricular dysfunction
• lung disease with secondary pulmonary hypertension
• pulmonary vascular disease
• pulmonic valve disease (PS, PR)
• tricuspid valve disease (TR, TS)
• percardial construction

Question 11

note: in addition to left and right sided problems, heart failure can be due to:
1. congenital heart disaese
2. shunt lesions (ASD, VSD, pDA)
3. high output heart faiure: anemic, hyperthyroid, patient has a high CO and hard to deal with the volume.

Question 13

note: even tho dyspnea might indicate a left sided pressure, it’s. a pretty broad symptom and can also indicate low cadiac output or pulmonary hypertension

Question 14

outline the heart failure classifications

Answer 14

based on functionality basicaly

Question 15

3 tools that can help diagnose heart failure

Answer 15

1. CXR
2. NT-proBNP
3. echocardiography or cardiac catheterization

Question 16

what are the arrows pointing to

Answer 16

Kerly B lines. indicative of congestive heart failure (left side)or pulmonary hypertension or both

Question 17

Answer 17

peribronchial cuffing

Question 18

key finding in this xray that can indicate chronic heart failure

Answer 18

cardiomegaly. the heart is over 50% of the diaphragm width.

Question 19

BNP can help assess heart failure likelihood. It is ___ dependent.

Answer 19

it is age dependent.

Question 20

T/f a normal ejection fraction can rule out heart failure

Answer 20

false. HRPEF is a thing

Question 21

Look at this diagram

Question 22

even though sodium and water retention “makes sense” why is actually a decompensatory compensation process in the long run?

Answer 22

NA and H2O retension occurs because the kidneys sense poor perfusion due to reduced cardiac output. CO is reduced because EF is reduced. The ventricle cant contract very well, leaving more blood in the heart and increasing prelaod. thus, there’s enoguh blood, but not enough blood flow cause the heart cant pump it everywhere. the body starts to keep fluid even though we already are fluid overloaded— increases further preload resulting in ventricular overdilation (global remodeling), s3 sound, and peripheral edema.

Question 23

what 3 neurohormonal systems are activated by a low stroke volume and BP

Answer 23

1. sympathetic nervous system
2. renin angiotensin aldosterone system3
3. adi/vasopressin

Question 25

Why is increased vascular tone initially helpful but actually deterimental in the long run?

Answer 25

increased vascular tone is helpful initially because the body snesses the reduced EF resulting in reduced CO resulting in poor perfusion and low blood pressure. You need blood pressure to live. therefore, the body compensates by increase the resistance and thus increasing the afterload of the heart - this maintains the BP initially, but increasing the afterload puts more pressure on the ventricle to eject blood, further reduceing the EF and SV and thus CO and also contributing to hypertrophy (global appearnce)

Question 26

the sympathetic nervous system is turned on when the body sense a decrease in perfusion. why is it good in the short term but bad in the long term

Answer 26

chartcholamine release increases HR and thus CO. - BUT it also causes the heart to beat faster and thus increases myocardial energy when the ventricle is already struggling with increased afterload, hypertrohpy, increased preload etc. - it causes adverse remodelling with cardiac myocyte hypertroph and death.promotes arrhthmias

Question 27

overall heart failure is a failure of the circulatory system to 1. provide adequate cardiac output 2. to do so only at the expernse of elevated filling pressures (causes S3 sound) 3. and maladaptive neurohormonal responses lead to exaggerated sodium and water retention increased afterload chronic catecholamine stimulation progressive ventricular dysfunction

Question 28

biggest cause of right heart failure

Answer 28

left heart failure thats why someone with congestive heart failure (left problem) can still have peripheral edema which is a right heart syndrome