Robbins 9th ed - Chapter 12 - The Heart - Congestive Heart Failure (1)

Question 1

What is the definition of “heart failure”?

Answer 1

Insufficient cardiac output to meet the metabolic demands of the body.

Question 2

Name the six broad categories that can cause cardiac failure (either acutely or chronically).

Answer 2

1) Pump failure (systolic dysfunction or diastolic dysfunction)
2) Flow obstruction (e.g. valve stenosis)
3) Regurgitation (e.g. MR or AR)
4) Shunted flow (e.g. patent ductus arteriosus)
5) Disorders of electrical conduction (arrhythmia)
6) Rupture of heart or great vessel (e.g. gunshot wound, aortic dissection + rupture)

Question 3

Name four causes of left heart failure.

Answer 3

1) IHD
2) Hypertension
3) Aortic / Mitral valve disease
4) Primary myocardial disease (e.g. HOCM)

Question 4

What is the definition of systolic dysfunction?

Answer 4

Reduced ejection fraction.

Question 5

What is the definition of diastolic dysfunction?

Answer 5

Stiff ventricles unable to relax and fill during diastole, causing backing-up of blood and reduced venous return. This may only be a problem during exercise.

Question 6

What is the most common cause of diastolic dysfunction? Is it more common in women or men?

Answer 6

Hypertension is the most common cause. It’s more common in women.

Question 7

Name four causes of right heart failure, starting with the most common.

Answer 7

1) Left heart failure (most common cause)
2) Pulmonary hypertension
3) Tricuspid / Pulmonary valve disease
4) Others (e.g. myocarditis, cardiomyopathy)

Question 8

Name some clinical / pathological features of right heart failure.

Answer 8

• Congestive hepatomegaly
• Congestive splenomegaly
• Ascites
• Peripheral oedema
• Pleural effusion / Pericardial effusion
• Renal congestion

Question 9

Name some clinical / pathological features of left heart failure.

Answer 9

• LVH
• Left ventricular dilatation
• Left atrial enlargement (and risk of AF)
• Pulmonary congestion and oedema
• Reduced renal perfusion
• Reduced brain perfusion

Question 10

With regard to cardiac ventricles: What is pressure-overload hypertrophy? What is volume-overload hypertrophy?

Answer 10

Pressure hypertrophy = caused by increased afterload = increased wall thickness with normal or reduced cavity size
Volume hypertrophy = caused by increased preload = dilated cavity size, where the wall thickness may be normal.
In both types, the weight of the heart is heavier because there is more muscular tissue

Question 11

What is meant by “activation of neurohumeral systems”?

Answer 11

This occurs in response to increasing demand of the tissues to increase cardiac output. There is:

• Baroreceptor reflex –> Release of noradrenaline –> Increased HR + contractility
• Activation of RAAS
• Release of ANP

Question 12

What is cor pulmonale?

Answer 12

Cor pulmonale is RV hypertrophy / dilatation / failure, secondary to pulmonary hypertension.

Question 13

Name the four major categories that can cause cor pulmonale.

Answer 13

1) Lung parenchymal disease (e.g. COPD)
2) Pulmonary vessel disease (e.g. recurrent PEs)
3) Disorders affecting chest movement (e.g. obesity)
4) Factors causing pulmonary artery constriction (e.g. hypoxia)