Lecture 10 "Heart Failure"

Question 1

what is the most common etiology of heart failure?

Answer 1

ischemic cardiomyopathy

Question 2

what is the most common etiology of heart failure in younger people?

Answer 2

dilated cardiomyopathy

Question 3

metabolic cardiomyopathy is caused by what?

Answer 3

hypothyroidism

Question 4

what happens to calcium transport in heart failure?

Answer 4

decreased Ca transport, and decreased Ca store in SR

upregulation of Na/Ca exchangers

Question 5

what happens to potassium flow in heart failure?

Answer 5

downregulation of K channels

increased risk of DADs

Question 6

what is compensated heart failure?

Answer 6

filling pressure is increased, but it is compensated via the frank-starling mechanism

EF is still reduced

Question 7

what is decompensated heart failure?

Answer 7

SV begins to fall despite increased EDV

Question 8

what is the sump-pump effect?

Answer 8

the ventricle pumps out less, so the feed pressure rises

Question 9

what are the three etiologies of increased filling pressure?

Answer 9

sump-pump effect

sympathetic venoconstriction shifting blood centrally

increased salt and water retention

Question 10

what is BNP?

Answer 10

it is a common marker for the diagnosis of heart failure

its secreted from the ventricular myocardium in response to volume expansion

Question 11

at what BNP levels are heart failure unlikely, and likely?

Answer 11

unlikely at < 100 pg/ml

likely at > 300 pg/ml

Question 12

what are some causes of false positives on a BNP test?

Answer 12

pulmonary HTN
pulmonary embolism
hyperthyroidism
renal failure

Question 13

what is the earliest symptom of LV dysfunction?

Answer 13

dyspnea on exertion

Question 14

what abnormalities would be seen on a physical exam for a patient with compensated heart failure?

Answer 14

nothing

Question 15

what abnormalities would be seen on a physical exam for a patient with decompensated heart failure?

Answer 15

pulmonary rales
JVD
pulmonary edema
ascites and hepatomegaly

Question 16

what is systolic heart failure?

Answer 16

an abnormality of ventricular emptying due to lack of contractility or increased afterload

Question 17

what is diastolic heart failure?

Answer 17

impaired filling of the ventricle due to an abnormality of diastolic relaxation

Question 18

what leads to eccentric hypertrophy?

Answer 18

volume overload

Question 19

what leads to concentric hypertrophy?

Answer 19

pressure overload

Question 20

what are three signs of left-sided heart failure?

Answer 20

dyspnea
orthopnea
fatigue

Question 21

what are two signs of right-sided heart failure?

Answer 21

peripheral edema

right upper quadrant pain due to hepatic enlargement

Question 22

what are three ways to decrease cardiac work, thus decreasing O2 demand?

Answer 22

rest

reduction of arterial pressure with vasodilators

reduction of filling pressure with venodilators

Question 23

what drugs are used to prevent arrhythmias in patients with heart failure?

Answer 23

beta blockers

Question 24

what are four drugs that can be used to improve inotropy?

Answer 24

digoxin
milrinone
dobutamine
dopamine

Question 25

what are three medical treatments for diastolic heart failure?

Answer 25

allow for adequate filling with BBs and CCBs

control volume overload with diuretics

maintain NSR with cardioversion or amiodarone

Question 26

at what EF would an ICD be placed?

Answer 26

< 35%

Question 27

at what QRS length would an ICD be placed?

Answer 27

> 120 ms

Question 28

1/3 of patients with heart failure have what kind of heart block?

Answer 28

LBBB