26

Question 1

Define HF

Answer 1

• Inadequate blood flow for metabolic needs

Question 2

Primary HF

Answer 2

• Cause: cardiac origin, peripherally affected
• Can’t empty –> systolic

–> weakened contractility (low ejection fraction)

• Can’t fill –> diastolic

–> muscular hypertrophy (low volume)

Question 3

describe the pathophsiology of HF

Answer 3

• Begins with decreased cardiac output
• compensate by increased volume (retain Na+ and H20)
• Heart response limited to:

–> increase volume (filling) - increase left ventricular end diastolic volume

–> increased fiber length (spilling) - increase force of contraction

–> starlings law (SV and LVEDV increase together)

Question 4

describe the bodies response to tissue ischemia

Answer 4

• increases contractility, rate, peripheral resistance (epinephrine, norepinephrine)
• Increase ischemia (systolic) or hypertorphy (diastolic) (increased O2 demand, increased work load)
• renen/angiotensin activated as if hypovolemic

Question 5

describe symptoms of LV Failure

Answer 5

• Dyspnea (exertion, recumbent, nocturnal, resting)
• Diminished exercise capacity (output down)
• nocturia (recombent diuresis)

Question 6

describe sysmptoms of RV failrue

Answer 6

• peripheral edema
• Edema of bowel wall can impair med absorption

Question 7

describe NYHA functional classification

Answer 7

• Class 1 - no limitation
• Class 2 - slight limitation of activity (ordinary activity precipitates dyspnea, fatigue, angina)
• Class 3 = makred limitation (less than normal activity)
• Class 4 - symptoms at rest

Question 8

describeing physical exams of LEFT HF

Answer 8

• Pallor, cool extremities
• anxiety, dyspnea at rest
• pulses normal to rapid, weak
• blood pressure varies
• Pulmonary rales, pleural effusion

Question 9

physical exam of Right HF

Answer 9

• Hepatojugular reflux
• kassmauls sign

–> paradoxical JVD from increased R chest pressure (inhallation normally increases blood return (rise in JVD)

• congestive hepatomegally (ascites)
• Edema (symmetrical, pitting, dependent)

Question 10

describe goals of therapy for HF

Answer 10

• relieve symptoms
• improve NYHA functional class
• decrease frequency and intesnity of tx
• delay progression of myocardial dysfunction
• reduce premature HF mortality

Question 11

therapy at Stage A

Answer 11

• Stage A = pre-symptoms, at risk, heart ok

- ACE inhibitors

• beta blockers may be benefit

Question 12

therapy at stage B

Answer 12

• Stage B = no symptoms, cardiac structure changes)
• Goals

–> prevent worsening dysfunction

–> improve symptoms

–> reduce disability and hospitalizations

• Drugs = ACEIs, beta blockers, diuretics, digoxin (?)

Question 13

Therapy at stage C

Answer 13

• Stage C = structural changes and symptoms present)
• Goals:

–> reduce premature HF mortality

–> reduce diability and hospitalization

–> improve symptoms and functional capacity

• Drugs = ACEI, spironolactone, diuretics, beta blockers

Question 14

therapy at stage D

Answer 14

• Stage D = advnaced disease, continued symptoms, require aggressive therapy)
• goals:

–> palliation (feel better)

–> reduce hospitalizations

• Drugs = improve symptoms (cannot salvage the patient)

Question 15

Describe adverse effects of angiotensin II in HF

Answer 15

• mediated by AT-1 receptors
• Myocyte hypertrophy
• myocyte apoptosis
• proliferation of fibroblasts

**ACEI are now MANDATORY agents for tx of HF**