Heart Failure

Question 1

What is the most common cause of heart failure?

Answer 1

Cardiac Muscle Dysfunction; general term describing altered systolic and/or diastolic activity of the myocardium

Question 2

What is Left-Side Heart Failure; what it leads to?

Answer 2

Secondary to Left Ventricular insult:
- Reduction of Cardiac Output and SV
- Leads to a backup of fluid into the Left Atrium and Lungs

Question 3

What are the two hallmark pulmonary signs of Left-Sided Heart Failure?

Answer 3

Shortness of Breath (SOB)

Cough

• Think of pulmonary complications secondary to increase fluid build-up in the lungs

Question 4

What is Right-Sided Heart Failure?

Answer 4

Secondary to Right Ventricular Insult: Due to conditions that increase Pulmonary Arterial Pressure

• Increases afterload, increasing demands on the Right Ventricle
• Blood not effectively ejected from RV, leading to build up into the right atrium and venous vasculature.

Question 5

What are the two hallmark peripheral signs of Right-Side Heart Failure?

Answer 5

Venous Distension

Peripheral Edema

Question 6

What is Systolic Dysfunction?

Answer 6

Heart Failure with Reduced Ejection Fraction (HFrEF)

Compromised contractile function of the ventricles causing reductions to:
- Stroke Volume
- Cardiac Output
- Ejection Fraction: (EF less than 40%)

Question 7

What is the Ejection Fraction for Systolic Dysfunction; HFrEF

Answer 7

EF = Less than 40%

Question 8

What is Diastolic Dysfunction?

Answer 8

Heart Failure with Preserved Ejection Fraction (HFpEF)

Compromised diastolic function of the ventricles.
- Ventricles cannot relax and fill properly during diastole

Reduces:
- Stroke Volume
- Cardiac Output

EF remain preserved remaining between 55% and 75%

Question 9

What is Ejection Fraction for Diastolic Dysfunction; HFpEF?

Answer 9

Ejection Fraction = 55%-75%

• No reduction in ratio due to no change in contractile ability of the ventricles

Question 10

Patients experience an acute bout of heart failure will most likely to have what type of heart rate at rest?

Answer 10

Tachycardia

Question 11

What is the sequence of events that occurs due to congestion of blood in the left ventricles?

Answer 11

Sequence:
- Increases Left Ventricular EDV
- Increases LV pressure
- Increase pressure in LA and pulmonary veins
- Increases Hydrostatic pressure > causing fluid to move into the interstitial space of the lungs
- Leading to Pulmonary Edema

Question 12

How is heart failure connected to kidney function?

Answer 12

Low blood volume pumped from the heart leads to less blood going to the kidneys

• Kidneys go into renal failure

Question 13

What lab values are important relating to the kidneys in acute heart failure exacerbation?

Answer 13

Monitor:
BUN
Plasma Creatinine Levels

Question 14

What are the hallmark signs of decompensation, relating to congestion and increased ventricular filling pressures?

Answer 14

• Fatigue
• Dyspnea
• Edema (pulmonary and peripheral)
• Weight Gain (Fluid)
• S3 Heart sounds; Ventricular Gallop
• Renal Dysfunction

Question 15

Is LE pitting edema associated with CHF unilateral or bilateral?

Answer 15

Bilateral

Question 16

What pathological heart sound is associated with CHF?

Answer 16

S3; Ventricular Gallop

Question 17

What is Orthopnea?

Answer 17

SOB in a recumbent position

Question 18

In patients with CHF assuming a recumbent position and subsequently elevating the legs will cause what?

Answer 18

Fluid moves back to the heart increasing preload.

• A failing heart cannot keep up with the additional load

Question 19

What are some common radiological findings in Heart Failure?

Answer 19

• Enlarged Cardiac Silhouette. Possible pathological hypertrophy of the muscles
• Opacities (/grey/light/white areas) in the lung fields
• Blunting of the costophrenic angle

Question 20

What is Ejection Fraction?

Answer 20

The amount of blood that is pumped out of the heart in relation to how much was there to begin with.

I.e: SV and EDV

Question 21

What is the most common cause of right sided heart failure?

Answer 21

Left Side Heart Failure