Lecture 6 Heart Failure

Question 1

HF is due to impairment of the ability of the heart to _____ _____ or to ____ blood

Answer 1

fill with; eject

Question 2

HFrEF stands for ?

What dysfunction is it due to?

also called ___ HF

Answer 2

Heart Failure with reduced Ejection Fraction;

systolic,

Left

Question 3

What does HFpEF stand for?

What dysfunction is it due to?

also called _____ HF

Answer 3

HF with preserved Ejection Fraction;

diastolic;

right

Question 4

HFrEF is usually caused by ____ with antecedent ____

Answer 4

coronary artery disease;

MI

Question 5

HFpEF is usually seen in what population of people?

Answer 5

older women with HTN

Question 6

Stage A of the new HF classification is defined as:
Stage B = _____
Stage C = _______
Stage D =

Answer 6

at risk for CHF;
asymptomatic structural disease (ie previous MI)
previous/current symptoms,
refractory symptoms

Question 7

what group has the highest risk for HF?

Answer 7

blacks

Question 8

what pulmonary signs are seen in patients with HF?

Answer 8

diffuse wet rales/crackles

Question 9

Where is the PMI displaced in HF?

Answer 9

lateral, due to enlarged heart

Question 10

in HFrEF, there is high _____ venous pressure

Answer 10

pulmonary

Question 11

pulmonary edema is seen as edema located in the ____ on CXR. The _____ ____ vessels in the lung fill up first. This is called ____

Answer 11

bases;
super apical;
cephalization

Question 12

3 special symptoms of L HF

Answer 12

orthopnea, paroxysmal nocturnal dyspnea, rales (due to edema)

Question 13

There may be a ____ ____ and dilated ____ veins due to high hepatic venous pressure in patients with L Hf

Answer 13

nutmeg liver;

hepatic

Question 14

In HF, there is often increased ____ _____ pressure

Answer 14

jugular venous (seen as JVD)

Question 15

Orthopnea and paroxysmal nocturnal dyspnea is due to increased ____ _____ from redistribution of blood

Answer 15

increased venous return

Question 16

3 classic signs of HFpEF (according to FA)

Answer 16

hepatomegaly (nutmeg liver), JVD, peripheral pitting edema

Question 17

other symptoms of right sided HF include _____ swelling, _____ gain, fatigue, and ______

Answer 17

ankle, weight;

cyanosis/ascites

Question 18

HF:
decreased blood flow to the _____ causes an increase in firing of the _____ ____ Cells. this causes increased produciton of renin

Answer 18

kidney;

Juxta-glomerular apparatus

Question 19

In addition to renin activation, decreased cardiac output activates the ____, leading to vaso____, ____ afterload, and ____ contractility

Answer 19

Sympathetic NS; constriction, increased, increased

Question 20

combined action of the SNS and renin system leads to an increase in ____ end _____ pressure

Answer 20

LV end diastolic

Question 21

A failing heart _____ _____ the frank starling curve due to inabaility to respond to an increased _____

Answer 21

falls off;

EDV

Question 22

HF can lead to ______ remodeling, causing dilatation and ____ regurgitation

Answer 22

LV;

mitral

Question 23

_____ lines are seen on CXR, indicating ____ pulmonary ____

Answer 23

kerley B (horizontal);
interstitial pulmonary edema

Question 24

many signs of HF on CXR may be absent in ____ ____ CHF

Answer 24

chronic compensated

Question 25

Pressure = _____ * _____ / _____

thus, a big heart is an ______ heart

Answer 25

tension * thickness / radius;

ineffecient

Question 26

_____ is generated by cardiomyocytes in the context of numerous triggers, such as myocardial stretch. it ____ in patients with CHF

Answer 26

BNP;

increases (ie greater than 100)

Question 27

_____ can evaluate chamber size, severity of LV or RV dysfunction, valve abnormalities, and more

Answer 27

Echocardiography

Question 28

Equation for ejection fraction:

what is it normally?

Answer 28

(LV EDV - LV ESV) / LV EDV;

normally 55-65%

Question 29

_____ training and cardiac _____ are supported by class A evidence in treatment of CHF

Answer 29

exercise; rehabilitation

Question 30

1st line treatment in chronic HF

Answer 30

ACE inhibitors or ARBs

Question 31

Diuretics and digoxin improve _____ but not ___________

Answer 31

symptoms, prognosis

Question 32

other treatments of CHF that improve symptoms and prognosis include ____/isorbide (vasodilator), beta blockers, _____ (Aldosterone antagonist), and implanted devices

Answer 32

hydralazine;

spirinolactone

Question 33

a flat starling curve represents decreased ____ _____ sensitivity patients with HFrEF

Answer 33

LV preload

Question 34

implanted devices include cardiac _____ and an implanted _____ _____

Answer 34

resynchronization;

cardioverter defibrillator

Question 35

_____ and milrinone are used for chronic ionotropic support in patients with severely chronic HF

Answer 35

dobutamine

Question 36

Acute decompensated CHF:

‘cold’ represents a decreased ______ (aka ________)
‘wet’ represents an elevated ______

Answer 36

cardiac index (Vasoconstriction/low perfusion)

pulmonary capillary wedge pressure (ie edema/congestion)

Question 37

acute CHF treatment:

____ Reduce fluid volume; vasodilators such as nitroglyerin reduce _____ and ____; and _____ augment contractility

Answer 37

diuretics;
preload, afterload;
inotropes