Week 5 Heart Failure and Cardiomyopathy

Question 1

In a heart with HF

Answer 1

:impaired ventricular contractility, increased afterload, or impaired filling of ventricles can lead to systolic or diastolic dysfunction

Systemic compensation occurs, including increases sympathetic activity, increase in specific hormone circulation, vasoconstriction, ventricular remodeling

Question 2

Cardiac output

Answer 2

volume of blood ejected from left ventricle each minute

typically 4-6 L/min

Question 3

CO =

Answer 3

HR x stroke volume

Question 4

Preload is also called

Answer 4

left ventricle end-diastolic pressure (LVEDP)

Question 5

Preload measures

Answer 5

stretch on L ventricle at the end of diastole

Question 6

Increased preload may occur in HF which can

Answer 6

increase cardiac muscle O2 requirement

Question 7

Many HF medications work to decrease preload

Answer 7

nitrates, diuretics, ACE inhibitors, ARB’s, calcium channels blockers

Question 8

Afterload

Answer 8

the force against which the L ventricle is contracting to eject blood

Question 9

Higher afterload =

Answer 9

lower cardiac output

Question 10

Lower afterload =

Answer 10

higher cardiac output

Question 11

Aortic pressures and peripheral pressures/resistance can

Answer 11

increase afterload

Question 12

Increase afterload =

Answer 12

decreased stroke volume = increase blood left in chambers of heart after systole

Question 13

In HFL elevated afterload leads to

Answer 13

long-term ventricular hypertrophy. While the body initial compensates with other systems, over time this leads to diastolic dysfunction (due to decreased compliance of ventricles – EF preserved) and eventually systolic dysfunction (EF reduced)

Question 14

Contractility is affect by

Answer 14

HR, afterload, preload, sympathetic/parasympathetic activation

Question 15

Contractility is decsribed as

Answer 15

the heart’s inherent ability to contract

Question 16

Contractility is related to the Frank-Starling mechanism

Answer 16

force of cardiac muscle contraction is proportional to resting length of the muscle fibers

Question 17

Increase preload =

Answer 17

increase contractility = increased stroke volume

Question 18

Ejection fraction

Answer 18

“A ratio or percentage of the volume of blood ejected out of the ventricles relative to the volume of blood received by the ventricles prior to contraction.”
Normal=60-70%

Question 19

Reduced ejection fraction – systolic dysfunction
(HFrEF)

Answer 19

impaired contractility, increase afterload

Question 20

Preserved ejection fraction – diastolic dysfunction
(HFpEF)

Answer 20

impaired ventricular filling

Question 21

Systemic compensations in HF

Answer 21

Increased blood volume (to increase preload)
Increased sympathetic nervous system activation
Increased HR
Decreased vagal/parasympathetic activation
Increased antidiuretic hormone
Increased renin-angiotensin-aldosterone mechanism activation (RAAS) – regulates blood volume and peripheral resistance
Increased peripheral resistance

Question 22

HFrEF

Answer 22

CAD**
MI
Valvular regurgitation
Dilated cardiomyopathy
Aortic stenosis HTN

Question 23

HFpEF

Answer 23

Left ventricular hypertrophy
Fibrosis of heart musculature
MI
Cardiac tamponade
Cardiomyopathies

Question 24

Class A

Answer 24

at high risk for HF but w/o structural heart disease or symptoms

Question 25

Class B

Answer 25

structural heart disease but w/o signs and symptoms of HF

Question 26

Class c

Answer 26

structural heart disease with current or prior symptoms of HF

Question 27

Class D

Answer 27

Refractory HF requiring specialized interventions

Question 28

Class I

Answer 28

no limitations of physical activity. Ordinary physical activity does not cause symptoms of HF

Question 29

Class II

Answer 29

Slight limitation of physical activity. Comfortable at rest but ordinary physical activity results in symptoms of HF

Question 30

Class III

Answer 30

Marked limitation of activity. Comfortable at rest but less than ordinary activity causes symptoms of HF

Question 31

Class IV

Answer 31

Unable to carry on any physical activity w/o symptoms of HF or symptoms of HF at rest

Question 32

HF common presentation

Answer 32

Dyspnea Orthopnea Fatigue JVD Peripheral edema Tachycardia Cachexia

Question 33

HF prognosis

Answer 33

HF prognosis is generally poor 5-year mortality ranges from 45-60% Patients with severe HF have a 1-year mortality rate of 60%

Question 34

Dilated

Answer 34

Dilation of heart chambers, particularly L ventricle

Question 35

Dilated causes

Answer 35

genetics (40%), toxins (chemo, drugs, alcohol), pregnancy, metabolic conditions involving the thyroid, myocarditis

Question 36

Dilated patho

Answer 36

L ventricle enlargement leading to decreased contractility and stroke volume

Question 37

Dilated symptoms similar to HF

Answer 37

dyspnea, orthopnea, edema, fatigue

Question 38

Restrictive

Answer 38

Stiffness of myocardium resulting in decreased/impaired filling and diastolic dysfunction

Question 39

Restrictive causes

Answer 39

amyloidosis (protein build-up) and sarcoidosis (inflammatory disease resulting in granulomas) Caused by increased fibrotic tissues in the heart

Question 40

Hypertrophic

Answer 40

Thickening of walls of heart chamber

Question 41

Hypertrophic interesting fact

Answer 41

accounts for 1/3 of sudden cardiac deaths in young athletic population, especially in football and basketball IOK(-p=[0

Question 42

Hypertrophic symptoms often present at

Answer 42

a younger age, but some people are asymptomatic

Question 43

Hypertrophic common symptoms

Answer 43

dyspnea and angina

Question 44

Valve disease is more common on

Answer 44

L side due to elevated pressures

Question 45

Risk factors for valve disease

Answer 45

RA, IVDA, smoking, obesity, congenital heart defects, family hx, autoimmune disorders, age

Question 46

Mitral valve stenosis

Answer 46

most cases caused by rheumatic fever

Question 47

Mitral valve regurgitation

Answer 47

caused by calcification, rupture of chordae tendinae or papillary muscles

Question 48

Mitral prolapse

Answer 48

leaflets prolapse into L atrium

Question 49

Mitral valve presentations

Answer 49

dyspnea, pulm HTN, pulmonary edema, fatigue, weakness

Question 50

Aortic regurgitation

Answer 50

aortic insufficiency

Question 51

Aortic regurgitation causes

Answer 51

congenital (2 instead of 3 leaflets to valve), ankylosing spondylitis, Marfan syndrome, HTN, endocarditis, rheumatic disease

Question 52

Aortic regurgitation common s&s

Answer 52

syncope, angina, SOB, weakness/fatigue

Question 53

Aortic stenosis

Answer 53

very common in older adults >65 y/o

Question 54

Aortic stenosis causes

Answer 54

calcification/atherosclerosis or rheumatic disease

Question 55

Aortic stenosis common s&s

Answer 55

syncope, angina, fatigue, dyspnea, decreased activity tolerance