26 Heart Failure

Question 1

what is the role of the heart

Answer 1

to provide a continuous supply of oxygen to the body parts using blood

Question 2

what is heart failure

Answer 2

clinical syndrome that affects the ability of the heart to provide sufficient blood to meet the body’s needs

Question 3

what are the two main types of heart failure

Answer 3

acute or chronic

but also classified as systolic or diastolic

Question 4

what can heart failure lead to

Answer 4

myocardial infarction

Question 5

Describe the anatomy of the heart

Answer 5

the heart is split up into 4 compartments which can be catagorised as the atria and the ventricles. Further catagorising as the left and right atrium and ventricles.
Think of it as a 2x2 grid.

The vena cava (superior above inferior below) goes into the right atrium which then passes through the tricuspid valve into the right ventricle where it goes through the semi lunar valve to the pulmonary artery.

pulmonary vein then goes to the left artia which then goes through the bicuspid valve to the left ventricle then to the aorta.

Question 6

describe the blood flow around the body

Answer 6

blood is pumped to the right atria via the vena cava once within it passes through the tricuspid valve into the right ventricle which then goes through the semi lunar valve as its pumped out to the pulmonary artery which takes blood to the lungs to exchange carbon dioxide for oxygen.

Pulmonary vein takes blood to the left ventricle which then passes through the bicuspid valve into the left ventricle which is then pumped through the semi lunar aortic valve into the aorta.

blood goes from the aorta to the artery to the arterioles to the capilaries to the venuoles to the veins to the inferior or superior vena cava back to the right atria.

Question 7

what is systolic heart failure

Answer 7

heart fails to pump the blood out of the ventricles fully

due to the thin and weak cardiac muscles.

Question 8

what is diastolic heart failure

Answer 8

heart doesnt fill the blood efficiently

due to larger cardiac muscles and thus reduced ventricle sizes

further classified as left and right side diastolic heart failure

failure of one part of heart leads to the dysfunction of other parts of the heart

usually the left side gets affected first and moves to the right.

Question 9

What is the total amount of blood pumped out per minute

Answer 9

normally 5L per minute

Question 10

what is stroke volume

Answer 10

amount of blood pumped out for every beat

Question 11

how do we calc cardiac output

Answer 11

stroke volume x heart rate = cardiac output

Question 12

how does compensation occur

Answer 12

increasing stroke volume or beating faster

Question 13

how do we calculate ejection volume/ fraction =

Answer 13

% of blood ejected by each beat

Question 14

describe systolic heart failure

Answer 14

systolic action contraction of cardiac muscle to eject blood which are weakened. so cant eject the blood properly anymore.

Mainly caused by cardiac muscle death, thinner muscles and enlarged ventricles

ejection fraction is reduced although the filling is unaffected.

Question 15

what are the causes of systolic heart failure

Answer 15

coronary heart disease as reduced blood supply to cardiac myocytes

cadiomyopathy heart muscle diseases weakens the muscles

valve disease can lead to backward blood flow to the atria. Increasing heart beat to meet demands

stenosis narrowing of aortic and pulmonary valves leading to reduction of stroke volume getting reduced so heart beats faster

cardiac arrhythmias leading to irregular heartbeats

Question 16

describe diastolic heart failure

Answer 16

diastolic action - filling blood in ventricles from atria, reduced ventricle size due to thickening of muscles therefore reduced blood volume in ventricles. Ejection fraction may be same due to the reduced ejected volume and filled volume.

Question 17

what is hypertrophy

Answer 17

reduces the ventricle sizes

Question 18

what is stiffening of muscles

Answer 18

due to lack of o2 and get hardened, affect the contraction

Question 19

what are the causes of diastolic heart failure

Answer 19

hypertension (chronic) due to other metabolic diseases leading to smaller blood vessels make the heart to work harder to pump the blood. Thus increase the muscle growth reduces the size of the ventricles.

aortic stenosis restricts blood flow and makes harder to pump increasing muscle growth

cardiac myopathy, hypertrophyincreased muscle growth therefore more O2 needed

Stiffening of muscles affects the contractions

endocarditis - infection in endocardium

age
disease
alcohol
medications

Question 20

describe the activation of sympathetic nervous system

Answer 20

induces sympathetic nervous system to enhance the cardiac activity

receptors mediated effects contraction and relaxation

prolonged activation leads to receptor desensitisation

Question 21

how do we increase the preload

Answer 21

release aldosterone which increase the filling volume and stroke volume

increased muscle activity

Question 22

cardiac hypertrophy

Answer 22

increase the muscle growth to increase ejection

Question 23

what is decompensation

Answer 23

increased activity requires more O2 and if body can supply more blood leads to cell death

Question 24

what are the symptoms of heart failure left sided

Answer 24

shortness of breath
swelling of feet and legs
chronic lack of energy
difficulty sleeping at night due to breathing problems
swollen or tender abdomen with loss of appetite
cough with frothy sputum 
increased urination at night
confusion and or impaired memory

Question 25

what are forward failure symptoms

Answer 25

Tiredness & fatigue - heart is not supplying enough blood/O2 to the body parts

Decreased urination – due to lack of blood supply & reduce fluid loss

Irregular heart beats – to supply more blood

Question 26

what are backward failure

Answer 26

Pulmonary oedema - fluid back up in lungs due (congestion) to reduced pumping

Difficulty breathing & coughing – due to congestion or fluid build up in lungs

Weight gain – due to fluid build up

Question 27

what are symptoms of right sided forward failure

Answer 27

Tiredness & fatigue – reduced supply to the lungs and thus lack of oxygenated blood

Irregular heart beats – to supply more blood

Question 28

what are symptoms of right side backward failure

Answer 28

Oedema - fluid back up in the body (congestion) extremities (e.g. legs) and jugular vein in the neck
Weight gain – due to fluid build up
Increased urination – due to more back up of blood

Question 29

how can we diagnose heart failure

Answer 29

X ray
Echocardiogram
Blood tests

Question 30

what are the 4 classifications of heart failure

Answer 30

asymptomatic - no symptoms and no impact on normal activities

Class 2 mild heart failure - mild symptoms + occasional oedema and somewhat limited ability to exercise

Class 3 moderate to severe heart failure - comfortable only at rest, noticeable limitations in exercise capacity

Class 4 severe heart failure - symptoms experienced at rest not able to exercise without discomfort

Question 31

what are early stage treatments of heart failure

Answer 31

regular exercise
balanced healthy diet
anti hypertensive drugs

Question 32

what are late stage treatments

Answer 32

anti hyper tensive drugs

ventricular assist device - directly connected to the affected ventricle and to the output blood vessel via a pump

cardiac resynchronisation therapy - pacemaker connected to affected atria / ventricles and make them beat at the same time with same rate

pacemaker connected to affected atria/ventricles and make them beat at the same time with same rate

pacemaker with defibrillator to delivers a shock and control the fibrillation

Question 33

what surgeries exist for heart failure

Answer 33

coronary angioplasty
CABG
Heart transplantation