T. Heart Failure

Question 1

Preload

Answer 1

venous return that build during diastole

is the amount of ventricular stretch at the end of diastole. Think of it as the heart loading up for the next big squeeze of the ventricles during systole. Some people remember this by using an analogy of a balloon – blow air into the balloon and it stretches; the more air you blow in, the greater the stretch.

the stretch of myocardium or end-diastolic volume of the ventricles and most frequently refers to the volume in a ventricle just before the start of systole.

Question 2

Contractility

Answer 2

?

Question 3

Afterload

Answer 3

the opposing pressure the ventricles have to generate to get the aortic values open

the amount of resistance the heart must overcome to open the aortic valve and push the blood volume out into the systemic circulation. If you think about the balloon analogy, afterload is represented by the knot at the end of the balloon. To get the air out, the balloon must work against that knot.

Question 4

Heart Failure

Answer 4

• An abnormal condition involving impaired cardiac pumping/filling
• Heart is unable to produce an adequate cardiac output (CO) to meet metabolic needs (inadequate stroke volume and cardiac output)
• not a disease but a “syndrome.”

Question 5

Ejection Fraction

Answer 5

• How much blood a ventricle pumps out with each contraction.
• An ejection fraction of 60 percent means that 60 percent of the total amount of blood in the left ventricle is pushed out with each heartbeat.
• Normal is 60-80%
• Under 40% may be evidence of heart failure orcardiomyopathy

Question 6

Heart failure with preserved ejection fraction

Answer 6

Impaired ability of the ventricles to relax and fill during diastole, resulting in decreased stroke volume and CO

occurs when the lower left chamber (left ventricle) is not able to fill properly with blood during the diastolic (filling) phase

Question 7

Mixed heart failure

Answer 7

Poor systolic function is further compromised by dilated left ventricular walls that are unable to relax.

Question 8

Biventricular failure

Answer 8

Both ventricles may be dilated and have poor filling and emptying capacity.

Question 9

Diastolic heart failure

Answer 9

• Heart has thick walls, so the ventricles cannot relax and fill during diastole. Decreased filling results in decreased stroke volume and CO, as well as venous engorgement in both the pulmonary and systemic vascular systems.
• L. ventricle loses ability to relax, muscle too stif and heart can’t fill blood in resting eriod between each beat.

Question 10

Systolic heart failure

Answer 10

• Heart has thin walls, so the left ventricle cannot pump effectively.
• L. ventricle loses ability to contract, heart can’t pump with enough force to push it through too much afterload

Question 11

Neurohormonal responses

RAAS

Answer 11

• compensatory mechanism for heart failure
• kidneys release reinin –> angiotensinogen –>angiotensin I–> angiotensin II–> release aldosterone (sodium and water retention)
• secretes Antidiuretic hormone (ADH)
>vasoconstriction.
>increase in cardiac contractility.
>Hypertrophy.

Response is known as the renin–angiotensin–aldosterone system (RAAS).

Question 12

Dilation

Answer 12

• Compensatory mechanism
• Enlargement of the chambers of the heart that occurs when pressure in the left ventricle is elevated.
• Initially an adaptive mechanism
• Eventually this mechanism becomes inadequate, and CO decreases

Question 13

Hypertrophy

Answer 13

• Compensatory mechanism
• Increase in muscle mass and cardiac wall thickness in response to chronic dilation
• Over time the thickening tissue needs more oxygen and has poor contractility since there’s no room

Question 14

Counterregulatory processes

Answer 14

• Released in response to increase in atrial volume and ventricular pressure
• Promote venous and arterial vasodilation, reducing preload and afterload
• Released natriuretic peptides:
– atrial natriuretic peptide (ANP),
– b-type natriuretic peptide (BNP)

Question 15

Left-sided Heart Failure

Answer 15

• Left ventricle often fails first
• Blood backs up into left atrium & pulmonary veins
• Causes pulmonary congestion & edema
• Patient has SOB and fluid accululation. Lungs sound wet. Cap refil impaired, edema,
• 2 types systolic and diastolic failure

Question 16

Right-sided Heart Failure

Answer 16

• Usually caused by left-sided heart failure
• Right ventricle may fail first possibly secondary to pulmonary disease such as COPD.
• Causes back up in venous system
• peripheral edema, vascular congestion of organs, GI tract

Question 17

Acute Decompensated Heart Failure (ADHF)

Answer 17

• Pulmonary edema, often life-threatening (lung alveoli are filled with serosanguineous fluid)
• failure of the LV creates an increase in pulmonary venous pressure.
• This results in engorgement of the pulmonary vascular system
• Won’t be able to breathe lying down at all, crackles or wheezes

Early 
--Increase in the respiratory rate 
--Decrease in PaO2 
Later 
--Tachypnea 
--Respiratory acidemia

a sudden worsening of the signs and symptoms of heart failure, which typically includes difficulty breathing (dyspnea), leg or feet swelling, and fatigue

Question 18

New York Heart Association Functional Classification of HF

Answer 18

Classes I to IV

1- no change in physical activity, ordinally function causes no problems
2 – fatigue/light symptoms, palpations/angina
3 – huge limitation of physical activity, normally comportabel at rest
4- can’t do nay activity without discomfort, actinivty increases discomfort

Question 19

DASH) diet

Answer 19

Dietary Approaches to Sop Hypertension

rich in vegetables, fruits and whole grains. It includes fat-free or low-fat dairy products, fish, poultry, beans and nuts. It limits foods that are high in saturated fat, such as fatty meats and full-fat dairy products.