Management of Heart Failure (Borgarelli)

Question 1

Definition of heart failure

Answer 1

any structural or functional disorder of the heart that impairs ventricular ability to fill or eject with blood

Question 2

What happens if there is too much sympathetic activity and excess RAAS, ADH and cytokine activation in response to decreased cardiac function?

Answer 2

Hypertrophy + remodeling and apoptosis of ventricles -> further decreased cardiac function + myocardial damage

Question 3

Example of how heart failure ≠ myocardial failure

Answer 3

E.g., MMVD: ventricle is contracting just fine (the issue is of the valve that causes regurg)

Question 4

Common signs of heart failure

Answer 4

• exercise intolerance
• weakness (muscle atrophy occurs due to impaired protein synthesis/degen. due to decr. CO)
• increased RR/RE (>30 bpm = left-sided HF)
• anorexia (due to passive GI congestion -> GI stasis & ulceration)

Question 5

ER: what initial tx should you always do for unstable pt w/ suspected acute onset of HF?

Answer 5

Furosemide + O2 supplementation (preferably in Snyder > flow-by)