HF- general

Question 1

what is heart failure?

Answer 1

when the CO is inadequate for the body’s requirement.

Question 2

what is stage 1 in NY classification of HF?

Answer 2

Heart disease present, but no undue dyspnoea from ordinary activity

Question 3

what is stage 2 in NY classification of HF?

Answer 3

comfortable at rest, dyspnoea on ordinary activities

Question 4

what is stage 3 in NY classification of HF?

Answer 4

less than ordinary activity causes dyspnoea, which is limiting

Question 5

what is stage 4 in NY classification of HF?

Answer 5

dyspnoea present at rest, all activity causes discomfort

Question 6

what is the commonest cause of RHF?

Answer 6

LHF

Question 7

signs and symptoms of hF are due to ____ _____

Answer 7

signs and symptoms are due to fluid retention

Question 8

Left ventricular failure and right ventricular failure may occur independently, or together as _____ heart failure.

Answer 8

Left ventricular failure and right ventricular failure may occur independently, or together as congestive heart failure.

Question 9

what are the causes of left heart failure ? 3 main

Answer 9

1. IHD, MIs
2. Cardiomyopathy
3. Valvular disease

Question 10

why does IHD (commonest cause) cause left sided heart failure?

Answer 10

this occurs because a part of the heart muscle has died and has been replaced by scar tissue which has impaired contractility. You then get a lower CO.

Question 11

how does cardiomyopathy lead to HF?

Answer 11

It changes the LV into a floppy sac which cannot contract very well.

Question 12

young people are more likely to have LHF due to _____

Answer 12

cardiomyopathy

Question 13

older people are more likely to have LHF due to _____

Answer 13

IHD

Question 14

why does valvular disease lead to LHF?

Answer 14

The heart is trying to pump blood forwards and if the valves prevent this they can reduce CO
The valve may be stenosed or incompetent (half of the blood ejected by the aorta falls back into the LV

Question 15

what are the three main causes of heart failure?

Answer 15

1. secondary to lhf
2. cor pulmonale
3. congenital heart disease

Question 16

why does cor pulmonale cause heart failure?

Answer 16

• If the lungs are hypoxic - one of the responses in the pulmonary vasculature is to constrict
• This means that the right heart has to work harder to push blood through to the left

Question 17

Systolic failure: inability of the ______ to contract normally, resulting in decreased ___
Ejection fraction is

Answer 17

Systolic failure:
inability of the ventricle to contract normally, resulting in decreased CO
Ejection fraction is

Question 18

what are the causes of systolic HF?

Answer 18

IHD, MI cardiomyopathy

Question 19

Diastolic failure : inability of the ventricle to relax and fill normally, causing increased ___ ______
- ejection fraction is >50%

Answer 19

Diastolic failure
inability of the ventricle to relax and fill normally, causing increased filling pressures
ejection fraction is >50%

Question 20

what are the causes of diastolic HF?

Answer 20

constrictive pericarditis, tamponade, restrictive cardiomyopathy, hypertension

Question 21

systolic and diastolic HF normally ______

Answer 21

systolic and diastolic normally coexist

Question 22

in chronic HF Venous _______ is common but arterial ______ is well maintained until very late

Answer 22

Venous congestion is common but arterial pressure is well maintained until very late

Question 23

what are the causes of low output HF?

Answer 23

1. pump failure
2. excessive preload
3. chronic excessive afterload

Question 24

what causes pump failure?

Answer 24

systolic and/or diastolic HF

decreased HR ( eg b blockers, heart block, post MI

negatively inotropic drugs

Question 25

what causes excessive preload?

Answer 25

mitral regurgitation or fluid overload (eg NSAID causing fluid retention)

Question 26

Fluid overload may cause LVF in a normal heart if ___ ______ is impaired or ___ volumes are involved (eg Iv running too fast

Answer 26

Fluid overload may cause LVF in a normal heart if renal excretion is impaired or big volumes are involved (eg Iv running too fast

Question 27

what may cause chronic excessive afterload?

Answer 27

aortic stenosis

Question 28

HIgh-output
This is rare. Here the output is normal or increased in the face of _____ ______. Failure occurs when the cardiac output fails to meet these needs.

Answer 28

HIgh-output
This is rare. Here the output is normal or increased in the face of increased demands. Failure occurs when the cardiac output fails to meet these needs.

Question 29

what are the causes of high output HF?

Answer 29

anaemia, pregnancy, hyperthyroidism, paget’s disease, arteriovenous malformation, beri-beri

Question 30

what are the consequences of high output HF?

Answer 30

initially features of RVF, later LFV becomes evident