Lecture 9: Cardiac Failure

Question 1

What is cardiac failure?

Answer 1

Heart is unable to pump sufficient blood to meet metabolic needs despite normal filling pressures and venous return

Question 2

What is congestive heart failure?

Answer 2

When the heart is not pumping properly so things back up and congest body and organs

Question 3

What is myocardial dysfunction?

Answer 3

Normal at rest, during stress there is deficient heart function - symptoms of heart failure

Question 4

What happened with cardiac failure before modern treatment?

Answer 4

50% of patients would die within 5 years

Question 5

What predicts life expectancy and how do you calculate this?

Answer 5

Ejection fraction

EF=SV/EDV

Question 6

What is systolic ventricular failure?

Answer 6

• reduced ejection fraction

- systolic effort abnormal, not pumping SV you should for normal EDV

Question 7

What is the timeline for systolic ventricular failure?

Answer 7

Systolic myocardial dysfuntion - low SV - high LVEDV - restore SV - low EF

Question 8

Where do you move on the frank starling curve in systolic ventricular failure?

Answer 8

Move up the curve - for same EDV lower SV

Question 9

What is diastolic ventricular failure?

Answer 9

• impaired filling at normal pressures
• reduced ventricular compliance
• myocardial concentric hypertrophy (aortic stenosis and systemic hypertension)
• pericardial constraint; fibrosis and fluid make pericardial sac thick and full and prevent normal filling

Question 10

Where can ventricular failure occur?

Answer 10

Right
Left
Right and Left
Left and then Right

Question 11

How is sympathetic NS a compensatory mechanism for heart failure?

Answer 11

-Increase sympathetic NS; vasoconstriction, increased HR, contractility & water retention

Question 12

How is activation of RAS a compensatory mechanism for heart failure?

Answer 12

Increase resistance and volume

Question 13

How does increasing vasopressin compensate for heart failure?

Answer 13

Increases BP

Question 14

How does endothelin compensate for heart failure?

Answer 14

Increase - vasoconstriction

Question 15

How does increased ANP compensate for heart failure?

Answer 15

ANP is a peptide released from atria when they are stretched - increases kidney sodium and water secretion

Question 16

What are the consequences of increased LVEDP/V?

Answer 16

• increased atrial pressure
• increased pulmonary vein pressures
• increased pulmonary capillary pressure; fluid moves from capillaries to lungs and decreased compliance and blood flow and pulmonary oedema

Question 17

What are the consequences of increased RVEDP/V?

Answer 17

• increased atrial pressure

- increased jugular venous pressure - organs and tissues swell

Question 18

What is hepatic congestion?

Answer 18

Due to increased RVEDP/V and increased jugular pressure - the hepatic vein going to the right heart transmits pressure to liver making it swollen and painful

Question 19

What is the treatment for heart failure?

Answer 19

• Increase contractility (not too much, don’t want to increase heart workload too much)
• Maintain normal heart rhythm and rate
• Reduce fluid retention