LP #112 Chronic Congestive Heart Failure

Question 1

• A state in which the heart cannot maintain adequate output or meeting body’s metabolic needs.
• d/t overfilling of chambers & hearts inability to acts as a pump

Answer 1

Congestive heart failure

Question 2

Congestion:

Heart failure:

Answer 2

• Overfilling of chambers

- Heart’ inability to act as a pump

Question 3

• inability to maintain adequate CO
• results in compensatory mechanisms
• initially short term

Answer 3

Physiology of CHF

Question 4

• high intracardiac P in L heart:
• causes back up of bld in?
• results in?
• high intracardiac P in R heart:
• causes back u in?
• results in sluggish?

Answer 4

L: pulmonary vv & pulmonary congestion & edema

R: venae cavae & venous return & anasarca

Question 5

Compensatory mechanisms:

• in early ears failure, compensation can meet body’s needs
• cardiac reserve (CR), is maintained initially via SNS activation; leads to:

Answer 5

-increase vascular tone 
To 
-increase vasoconstriction 
To 
-increase PR 
To 
-enhanced BF to vital organs (heart & brain)

Question 6

Decompensated CHF:

• if frank-starling mechanism fails=?
• common meds: diuretics
• increase urination to?
• decrease BVol= ?

Answer 6

• decrease CO (limits activity)
• decrease BVol
• decrease overfilling of heart

Question 7

• occurs early in heart failure
• increase morbidity
• increase mortality
• initially: increase contractility
• later: diastolic dysfxn & myocardial ischemia
• overall effect:
• increase ventricle wall mass
• decrease chamber vol.
• causes heart failure d/t excessive workload

Answer 7

Cardiac hypertrophy

Question 8

• aka backward heard failure
• d/t impaired blood ejection from heart- overloads venous system
• cause: increase ESV leads to increase ventricular filling P
• result: systemic or pulmonary edema
• involves:
• decrease contractility & CO
• volume overload
• P overload
• Sx’s mainly d/t decrease CO

Answer 8

Systolic CHF

Question 9

• aka forward heart failure
• 25-40% of all CHF cases
• d/t: impaired filling of ventricles in diastole (decrease EDV)
• decrease BF to kidneys= increase Na & H2O retention & edema
• decrease BF to various organs= weakness & fatigue
• involves:
• small ventricular chamber d/t ventricular hypertrophy
• poor ventricular compliance (delayed relaxation or decrease stretch during filling)
• same-sided atrial congestion

Answer 9

Diastolic CHF

Question 10

Combined systolic- diastolic CHF:

• oftern d/t?
• general s/s: ?

Answer 10

*Atherosclerosis

• fluid retention & edema
• respiratory dysfxn & cyanosis
• fatigue & limited exercise tolerance
• malnutrition & tissue wasting

Question 11

• d/t conditions that impair pulmonary circulation
• examples:
• valvular stenosis
• MI
• cardiomyopathies
• L-sided CHF
• pulmonary hypertension
• causes backup of blood in venous system
• increase P in R atrium/ventricle & venous system

Answer 11

Right-sided CHF

Question 12

Right-sided CHF major s/s?

Answer 12

• peripheral edema
• visceral congestion
• fatigue
• cyanosis

Question 13

• d/t acute MI & cardiomyopathies
• results in:
• decrease CO
• increase EDV P
• pulmonary congestion
• major s/s:
• pulmonary edema
• dyspnea on exertion
• coughing
• cyanosis
• long-term heart failure eventually involves both sides

Answer 13

Left-sided CHF