5. Heart failure

Question 1

Definition of Heart Failure

Answer 1

Where the cardiac output (performance) can’t deliver the necessaryamount of blood to the tissues

Question 2

does heart disease lead to heart failure

Answer 2

not always

Question 3

Cardiac Output =

Answer 3

Heart Rate X Stroke Volume

Question 4

Stroke volume is composed of

Answer 4

Preload
Afterload
Contractility

Question 5

Preload definition

Answer 5

initial stretching of cardiac myocytes
left ventricular end diastolic volume

Question 6

Increase in preload leads to

Answer 6

increased CO
increased congestion and O2 demand

Question 7

Afterload definition

Answer 7

the load which the heart pumps against
determined by vascular resistance

Question 8

Increase in afterload leads to

Answer 8

decreased CO
increased O2 demand
Hypertrophy

Question 9

Contractility definition

Answer 9

ability of the heart to contract

Question 10

Increase in contractility leads to

Answer 10

increased CO
increased O2 and energy demand
thus causing a decreased CO

Question 11

Types of heart failure is based on

Answer 11

course
demand
grade
function
direction
anatomy

Question 12

Heart failure based on course

Answer 12

Acute / Chronic

Question 13

Heart failure based on Demand

Answer 13

Absolute / Relative

Question 14

Heart failure based on Anatomy

Answer 14

Left / Right

Question 15

Heart failure based on Function

Answer 15

Systolic / Diastolic

Question 16

Heart failure based on Direction

Answer 16

Forward / Backward

Question 17

Heart failure based on Grade

Answer 17

Compensation / Decompensation

Question 18

What does the body prioritize in compensating for heart failure

Answer 18

Arterial BP in brain, heart, kidney
Venous BP at a low level

Question 19

What is chonotropic effect

Answer 19

increased heart rate

Question 20

what is inotropic effect

Answer 20

increased myocardial activity

Question 21

what does myocardial damage lead to

Answer 21

increased congestion –> RAAS becoming permanently activated –> increased heart rate –> vasoconstriction and myocardial hypertrophy

Question 22

cause of cardiac remodelling

Answer 22

autonomic nervous system
RAAS
inflammatory mediator

Question 23

macroscopic cardiac remodelling

Answer 23

shape and size (concentric and eccentric)

Question 24

microscopic cardiac remodelling

Answer 24

necrosis
apoptosis
fibrous tissue

Question 25

how does heart failure cause inflammation

Answer 25

increased inflammatory mediators –> myocardial fibrosis

Question 26

inflammatory mediators

Answer 26

paracrine molecules
interleukins
TNF alpha

Question 27

effects of inflammatory mediators

Answer 27

cardiac cachexia
decreased myocardium contractility
myocardial hypertrophy
free radical synthesis

Question 28

Left sided heart failure clinical signs

Answer 28

tachypneoa
cough
prerenal azotaemia
adam stokes syndrome

Question 29

Right sided heart failure clinical signs

Answer 29

Ascites
Congested jugular veins
positive hepatojugular reflux
pleural fluid

Question 30

Clinical Signs of Heart Failure

Answer 30

pale mm
prolonged crt
fatigue, weakness
exercise intolerance
weight loss
cachexia
tachycardia

Question 31

Aim of medication against HF

Answer 31

treat cause
relieve the symptoms
slow/ stop progression

Question 32

How to treat HF

Answer 32

decrease preload
decrease afterload
increase contractility
treat arrhythmias
treat neurohormonal overcompensation

Question 33

How to decrease Preload

Answer 33

furosemide & torsemide
Amiloride
Vasodilators
Pimobendan
Chlorothiazides

Question 34

How to decrease Afterload

Answer 34

Arterial Dilators - Amlodipine, Hydralazine
Pimodendan
Ace inhibitors

Question 35

How to increase Contractility

Answer 35

Pimobendan
Digoxin
Phosphodiesterase Inhibitors

Question 36

Emergency Treatment of HR
Priorities

Answer 36

Decrease Preload and Afterload
Increase contractility
Sedation - Butorphanol, ACP
O2 therapy