Sorescu_ Heart Failure Pt presentation

Question 1

No matter the etiology of heart problems, in heart failure _________ always increases

Answer 1

end diastolic volume and pressure… can be either left, right, or both

Question 2

diastolic LV dysfunction is caused by:

Answer 2

• stiff pump and or arteries (systolic pressure is normal)

Question 3

diastolic RV dysfunction is caused by:

Answer 3

• pulmonary HTN, pulmonary vasoconstriction, etc.

Question 4

define high cardiac output heart failure

Answer 4

• non cardiac heart failure; increased tissue demand of oxygen (hyperthyroidism, infection)… low systemic resitance

Question 5

what is normal arterial capillary pressure?

Answer 5

• 25 mmHg

Question 6

what is normal tissue pressure gradient?

Answer 6

• 8-15 mm Hg

Question 7

define the starling forces of renal physiology

Answer 7

1. glomerular filtration

2. tubular reabsorption

Question 8

how does heart failure affect the startling forces?

Answer 8

at normal physiology, afferent arteriole blood flow via renal artery needs to stay high, and pressure back to right atrium via renal vein flow needs to stay low

• blood flow in afferent arteriole (via renal artery) is reduced OR peritubular capillary (renal vein) is increased

Question 9

how to define left an d right sided heart failure based on capillary and venous pressure

what is the result of either of these?

Answer 9

• if left sided: decrased arterial capillary pressure
• if right sided: increase venous capillary pressure
• you get hypoxia and impaired oxygenation, and you get a wet lung (pulmonary edema)

Question 10

what is the result of acute heart failure in terms of fluid levels and movement?

Answer 10

• shift of fluid to the alveoli… rales on ausculation… white perihilar butterfl pattern of Pulmonary edema on CXR

Question 11

What happens in kidney during chronic heart failure?

Answer 11

• impaired GFR and tubular function causes chronic activation of Renin-angiotensin II via macula densa
• INCREASED SODIUM and WATER RETENTION, causing a volume overload and overworks the heart

Question 12

Besides working on the kidney, what else does angiotensin II work on?

Answer 12

• efferent arteriole… increases the resistance and actually decreases blood flow to the kidney

Question 13

what happens to the lung and fluid levels in chronic heart failure?

Answer 13

The mimatch in arterial capillary pressure/ venous capillary pressure gets back up of liquid into tissues;

• we get increased lymphatic drainage that shifts fluid from alveoli to lung interstitium and actually reduces the incidence of rales that we saw acutely

INSTESAD, we see vasccular congestion and pleural effusion

Question 14

what is the main perpetuator of the cycle of increased SVR? what is the result?

Answer 14

• Renin and angiotensin system… leads to reduced cardiac output in patients that already have LOW cardiac output… gives a big cycle

Question 15

Define acute heart failure

Answer 15

• cardiac output can be normal, high, or low
• NEED redistribution of intravascular volume to lungs
• Elevated SVR and LVEDP (except if you’re in high output cardiac failure)

acute heart failure: signs and symptoms of heart failing with evidence of elevation of LV or RV filling pressures (need that elevation of filling pressures)

Question 16

what is the surrogate value for afterload

Answer 16

systemic vascular resistance

Question 17

what is the most important value that contributes to SVR

Answer 17

MAP

Question 18

SIgns/symptoms of right v left sided heart failure

etiology of right v left sided heart failure

Answer 18

right: elevated right side cardiac pressures (RAP ? 10)
left: elevated left side cardiac pressures (PCWP >18)
right: sleep apnea/intrinsic lung disease/PE/ LEFT SIDED HF

Left: intrinsic left heart disease

Question 19

give most common symptoms of right v left sided HF

Answer 19

right: excessive peripheral edema
left: central edema (lung); can develop peripheral edema especially when L sided heart failure causes right sided heart failure

Question 20

contrast acute and chronic HF in terms of:

• clinical detection
• degree of symptom presentation
• signs
• labs
• CXR

Answer 20

clinically noisy (rapid development) v clinically silent (slow, allows for compensatory mechanisms)

very symptomatic v relatively asymptomatic (only ina dvanced stage)

obvious signs v subtle signs (only present in advanced stage)

both have leevated BNP level, but in chronic it’s even more elevated

normal heart size but pulmonary congestion/edema v cardiomegaly only with no evidence of pulmonary congestion (can see kerly b lines though)

Question 21

____ causes most symptoms from HF

Answer 21

• salt

- Heart failure causes salt retention, leading to water retention

Question 22

Give progression of chronic heart failure

Answer 22

a: risk factors
B: echo diagnosis of dysfunciton
C: start to have sypmtoms of CHF
D: advanced

Question 23

For stage c, what are the four classifications of activity/function

Answer 23

I: no problems with mobility

II: cannot go fast or up stairs

III: limited to house

IV: limited to bed

Question 24

what is the difference in remodling of heart in diastolic heart failure and systolic heart failure?

Answer 24

• systolic: dilated heart

- diastolic: hypertrophied heart

Question 25

Neurohormonal blockade targets what two hormones?

Answer 25

1. RAAS inhibitor

2. Norepinephrine/catecholamines (SNS)