Heart Failure I - patho

Question 1

Heart failure involves ____ failure and _____ failure

Answer 1

forward failure (low flow)

and backward failure (congestion)
- typically in response to low flow

Question 2

forward failure

Answer 2

Heart failure is the inability of the heart to pump blood forward at a sufficient rate to meet the metabolic demands of the body

Question 3

backward failure

Answer 3

ability to do so only if the cardiac filling pressures are abnormally high

Question 4

what controls CO?

What controls SV?

Answer 4

HR x SV

SV controlled by:
Inotropy of the ventricles (+)
Preload of the ventricles (+)
Afterload of the ventricles (-)

Question 5

Sum up Frank-starlin curve in 1 sentence

Answer 5

If you stretch the heart out more in diastole, it will contract more in systole.

Question 6

Determinants of Inotropy

Answer 6

Catecholaminergic/adrenergic stimulation

Calcium

Question 7

Describe the following axis for PV loops:
x-axis
y-axis
unlabled axis

Answer 7

x: volume inside the ventricles
y: pressure inside the ventricles

unlabeled axis: time

Question 8

Major divisions of HF

Answer 8

systolic HF
Diastolic HF
Left-sided
Right-sided

• note: systolic is usually accompanied by diastolic dysfunction and vice versa
• and LV failure often causes RV failure

Question 9

Types of ventricular remodeling and what type of HF does it typically result in?

Answer 9

Hypertrophied heart
- diastolic HF

Dilated heart
- systolic HF

Question 10

A weak/damaged myocardium = what type of HF?

Answer 10

Systolic failure due to loss of contractility

Question 11

Systolic dysfunction
what is it a problem in?
what is the hallmark?

Answer 11

A problem with squeeze
- ↓contraction / ↓ inotropy

Hallmark is:
1. Decreased ejection fraction
“HF with reduced ejection fraction” = HFrEF
“left ventricular systolic dysfunction” = LVSD

2. Ventricular enlargement
   “dilated cardiomyopathy” = DCM

• note: these are all the same terms. multiple names

Question 12

3 primary causes of systolic heart failure

Answer 12

1. direct destruction of heart muscle cells
2. overstressed heart muscle
3. volume overloaded heart muscle

Question 13

Diastolic dysfunction
what is it a problem in?
what is the hallmark?

Answer 13

Impaired filling
- ↓lusitropy / decrease in relaxation

Hallmark is 
1. Normal ejection fraction
“HF with preserved ejection fraction” = HFpEF
“preserved systolic function” = PSF
2. Ventricular wall thickening
“left ventricular hypertrophy” = LVH

Question 14

Right-sided heart failure

• what is it
• what does it cause

Answer 14

Stresses to the RV can cause it to fail to adequately pump blood through the lungs, which causes
↓ circulating blood flow (forward RV HF)
↑ venous pressures (backward RV HF)

Question 15

HFrEF

HFpEF

Answer 15

Heart failure with reduced ejection fraction
- systolic HF

heart failure with preserved ejection fraction
- diastolic HF

Question 16

↓ LV filling leads to ↓ CO

• what two structures senses this?
• how do they compensate?

Answer 16

Juxtaglomerular apparatus in kidney senses lower flow
–> Renin-
Angiotensin-Aldosterone (RAAS) activation

Carotid sinus / aortic baroreceptors sense lower pressure
–> Autonomic nervous system / adrenergic activation

Question 17

What does RAAS activation result in?

What about ANS/adrenergic activation?

Answer 17

RAAS: ↑ Sodium retention (↑ volume) + vasoconstriction

ANS/adrenergic activation: ↑ HR

• note: this is good short term compensatory mechanism, but is a double edge sword –> HF without intervention in the long run

Question 18

How is SV preserved?

What adverse side effects can result from ↑ volume?

Answer 18

STROKE VOLUME PRESERVED BY INCREASED
END-DIASTOLIC FILLING / PRESSURE (↑ contractility + preload)

↓ LV squeeze (systolic HF)
AND/OR ↑ stiffness (diastolic HF)

Supranormal filling pressures