SFP: heart failure

Question 1

What is the basic definition of heart failure?

Answer 1

Inability of the heart to produce CO sufficient to meet metabolic demands of the body, or to do so only at high filling pressures.

Question 2

Heart failure is considered an endpoint for which conditions?

Answer 2

Congenital heart disease, valvular disease, HTN, cardiomyopathy, ischemic heart disease.

Question 3

What is BNP?

Answer 3

It is produced by ventricular myocytes in response to wall tension from volume or pressure-volume overload. It is used to diagnose HF.

Question 4

Describe AHA stages of HF.

Answer 4

A: high risk for HF but no structural heart disease or symptoms. B: structural heart disease but no signs or symptoms of HF. C: structural heart disease with prior or current symptoms of HF. D: patients with refractory HF requiring intervention.

Question 5

Describe the stages of congestive HF.

Answer 5

1. No limitation of physical activity. 2. Slight limitation of physical activity. 3. (A) limitation of physical activity. (B) significant limitation of physical activity. 4. Unable to do any physical activity.

Question 6

What is isometric contraction? What measure is it associated with?

Answer 6

A muscle fiber is held in a fixed position on both ends and stimulated; this is the frank-starling relationship and illustrates preload.

Question 7

What is isotonic contraction? What measure is it associated with?

Answer 7

When a muscle can shorten against a fixed load; this is the concept of afterload.

Question 8

What is contractility?

Answer 8

Changes in the force of contraction independent of preload or afterload.

Question 9

What is the equation for cardiac output?

Answer 9

CO = SV x HR.

Question 10

What factors impact stroke volume?

Answer 10

Contractility, preload, and afterload.

Question 11

What are the 4 root causes of heart failure?

Answer 11

1. Impaired preload. 2. Increased afterload. 3. Impaired contractility. 4. Some combination of the above.

Question 12

What is systolic dysfunction?

Answer 12

Abnormal emptying of the ventricle, often due to impaired contractility or increased afterload.

Question 13

What is diastolic dysfunction?

Answer 13

Abnormality of relaxation or ventricle filling, usually related to preload.

Question 14

What does systolic dysfunction do to ESV, EDV, and EDP?

Answer 14

Increases all!

Question 15

What does systolic dysfunction do to preload? SV?

Answer 15

Increases both if contractility is preserved.

Question 16

What are some complications of systolic dysfunction?

Answer 16

Pulmonary or hepatic congestion.

Question 17

What are some common things that lead to diastolic dysfunction?

Answer 17

Fibrosis and scarring/hypertrophy.

Question 18

What is the pressure-contractility relationship in diastolic dysfunction?

Answer 18

Filling occurs at higher pressures despite normal contractility.

Question 19

What is an outcome of diastolic dysfunction?

Answer 19

Increased filling pressure leading to venous congestion.

Question 20

What are some factors associated with contractility that lead to systolic dysfunction and left sided HF?

Answer 20

1. MI. 2. Transient ischemia. 3. Chronic volume overload. 4. Dilated cardiomyopathy.

Question 21

What are some factors associated with increased afterload that lead to systolic dysfunction and left sided heart failure?

Answer 21

1. Aortic stenosis. 2. HTN.

Question 22

What are some factors associated with impaired relaxation that cause diastolic dysfunction and left sided HF?

Answer 22

1. LV hypertrophy. 2. Hypertrophic cardiomyopathy. 3. Restrictive cardiomyopathy. 4. Transient ischemia.

Question 23

What are some factors associated with obstruction of LV filling that lead to diastolic dysfunction and left sided HF?

Answer 23

1. Mitral stenosis. 2. Pericardial constriction or tamponade.

Question 24

What are some symptoms of left sided systolic dysfunction?

Answer 24

Dyspnea, fatigue, dulled mental status, impaired urine output.

Question 25

What are some symptoms of left sided diastolic dysfunction?

Answer 25

Dyspnea, hemoptysis, paroxysmal nocturnal dyspnea, orthopnea, palpitations.

Question 26

What are some physical findings of systolic dysfunction in left sided HF?

Answer 26

Tachycardia, diaphoresis, pallor.

Question 27

What are some physical findings of diastolic dysfunction in left sided HF?

Answer 27

Tachypnea, rales, pleural effusion, S3.

Question 28

What is the main cause of right sided HF?

Answer 28

Left sided HF.

Question 29

What is cor pulmonale?

Answer 29

Right sided HF due to pulmonary disease.

Question 30

Acutely, what causes cor pulmonale?

Answer 30

Pulmonary embolism.

Question 31

Chronically, what causes cor pulmonale?

Answer 31

COPD, chronic pulmonary embolism, primary pulmonary HTN, chronic apnea.

Question 32

What are symptoms of right sided systolic dysfunction?

Answer 32

Dyspnea on exertion and fatigue.

Question 33

What are symptoms of right sided diastolic dysfunction?

Answer 33

Peripheral edema, right upper quadrant pain, weight gain or anorexia, palpitations.

Question 34

What are some physical findings of systolic dysfunction in right sided HF?

Answer 34

Tachypnea, tachycardia.

Question 35

What are some physical findings of diastolic dysfunction in right sided HF?

Answer 35

Cachexia, JVD, hepatomegaly/nutmeg liver, right sided heave.

Question 36

What are the 3 main compensatory mechanisms?

Answer 36

1. Frank-starling. 2. Neurohormonal regulation. 3. Ventricular remodeling.

Question 37

How does the frank starling mechanism work as a compensatory mechanism?

Answer 37

The reduced stroke volume leads to a higher-than-normal volume in diastole. As a result of the excess preload, SV will increase in the short term.

Question 38

Describe SNS regulation in heart failure.

Answer 38

The low CO results in lower stimulation of baroreceptors. This leads to an upregulation of the SNS, causing release of norepi to help increase venous return and ventricular filling.

Question 39

What are some long-term issues of continued SNS stimulation in HF?

Answer 39

Kidney issues, decreased b adrenergic responsiveness, myocyte necrosis, arrhythmia, vascular hypertrophy.

Question 40

Describe RAAS in terms of compensating for HF.

Answer 40

It is activated later in the course of HF and works to increase CO by increasing blood volume and thus pressure to allow blood to return to the heart.

Question 41

Describe ventricular remodeling as a compensatory mechanism.

Answer 41

The heart thickens in response to wall stress, but this results in the heart being less compliant and having a much higher metabolic demand while maintaining the same capillary content.