heart failure 2

Question 1

diastolic failure

Answer 1

1. ↑ stiffness requires ↑ pressure to achieve the same LV filling volume
2. difficulty/impaired filling
3. ↓lusitropy / decrease in relaxation
4. Produces ↓ SV

Question 2

hallmark of diastolic dysfunction is

Answer 2

1. normal ejection fraction

2. ventricular wall thickening

Question 3

Primary causes of diastolic HF

Answer 3

1. high afterload/pressure overload
2. myocardial thickening/fibrosis
3. external compression

Question 4

High afterload / pressure overload caused by?

Answer 4

1. Hypertension (long-standing)
2. Aortic stenosis
3. Dialysis (inadequate volume removal)

Question 5

Myocardial thickening / fibrosis can be caused by

Answer 5

1. Hypertrophic cardiomyopathy

2. Primary restrictive cardiomopathy

Question 6

External compression

Answer 6

1. Pericardial fibrosis / constrictive pericarditis

2. Pericardial effusion

Question 7

Primary causes of right-sided HF

Answer 7

1. Left heart failure
2. Lung disease / pulmonary HTN / RV pressure overload
3. RV Volume overload
4. Damage to the RV myocardium

Question 8

Left heart failure can be caused by?

Answer 8

Backward HF from LV dysfunction stresses the right side by increasing pulmonary venous pressures

Question 9

Lung disease / pulmonary HTN / RV pressure overload can be caused by?

Answer 9

1. Called “cor pulmonale” when primary lung dz causes HF

2. COPD, primary pulmonary hypertension, sleep apnea

Question 10

RV Volume overload can be cause by?

Answer 10

1. Shunt (interatrial septal defect)

2. Tricuspid regurgitation

Question 11

Damage to the RV myocardium

can be caused by?

Answer 11

1. Isolated RV infarct

2. Myocarditis

Question 12

Clinically HF forms coexist

Answer 12

1. Systolic dysfunction is typically accompanied by diastolic dysfunction and vice versa
   a. Fibrosis (scar tissue can’t contract or relax)
   b. Ischemia (relaxation is energy dependent)
2. LV failure often causes RV failure

Question 13

The cycle of HF: the problem

Answer 13

decreased CO

Question 14

The cycle of HF: the solution?

Answer 14

1. Compensatory responses
2. Neurohormal activation
3. Frank-Starling (increasing preload)
4. Ventricular hypertrophy and dilation

Question 15

heart failure can be compensated for by?

Answer 15

frank starling by the SV being preserved by increased end diastolic filling/pressure

Question 16

chronic neurohormonal activation promotes HF by?

Answer 16

1. adrenergic activation

2. renin-angiotensin activation

Question 17

adrenergic activation leads to

Answer 17

1. vasoconstriction
2. tachycardia
3. inotropic augentation

Question 18

renin-angiotensin activation leads to

Answer 18

1. vasoconstriction

2. salt/water retention

Question 19

neurohumoral activation leads to

Answer 19

1. NE
2. angiotension
3. aldosterone

Question 20

remodeling growth of cardiac muscle call can be

Answer 20

1. hypertrophy
2. hyperplasia
3. necrosis
4. fibrosis

Question 21

consequences of cardiac remodeling

Answer 21

1. decreased contractile force
2. decreased dynamic function
3. increased diastolic stiffness

Question 22

compensation for low CO

Answer 22

1. sodium/fluid retention
2. hypertrophy
3. dilation
4. tachycardia