Sketchy Path: Congestive Heart Failure Pathophysiology

Question 1

What is the defective process in systolic heart failure?

Answer 1

Systolic heart failure presents with reduced ejection fraction.

(This is represented by the fraction of cake that is falling overboard next to the guy ejecting the champagne cork.)

Question 2

What percent of ejection fraction is diagnostic of HFrEF?

Answer 2

Less than 40% (like the cake-serving utensil and plate that look like the number 40)

Question 3

What is used to determine ejection fraction?

Answer 3

Ultrasound (like the ultra-loud horn on deck)

Question 4

Reduced ____________ leads to systolic heart failure.

Answer 4

cardiac contractility (like the server’s weak arms)

Question 5

How does HFrEF affect end-diastolic volume?

Answer 5

It increases EDV because less blood is pumped out during systole.

(Think of the groomsmen overinflating the heart.)

Question 6

What is the central defect in diastolic heart failure?

Answer 6

Decreased compliance in the ventricles leads to impaired filling. Ejection fraction is preserved.

(Think of the waiter on the other side of the ship lifting the cake with 55% on it –representing normal EF –next to the bride with the diastolic diamond: she’s having trouble filling the glasses just like how the heart can’t fill in HFpEF.)

Question 7

How does diastolic heart failure affect end-diastolic volume?

Answer 7

The EDV will be normal, but the pressure required to achieve the volume will be increased compared to normal.

(Think of how the bridesmaid is inflating the heart balloon: it’s normal in size but she’s really straining to get it there.)

Question 8

What things can cause systolic heart failure?

Answer 8

• ACS (like the musician with the coronary plaque crown and the broken guitar string)
• Dilated cardiomyopathy (like the giant, floppy heart bag next to the alter)
• Valve regurgitation (like the jester hat on the guy regurgitating over his shirt)
• VSD (like the unbuttoned shirt on the jester)

Question 9

What things can cause diastolic heart failure?

Answer 9

• Chronic hypertension (like the princess with steam coming out of her ears)
• Aortic stenosis (like the stenotic hat that the princess is wearing)
• Hypertrophic cardiomyopathy (like the bridesmaid with the giant heart bagpipes)
• Restrictive cardiomyopathy (like the heart caught in a net in the waterwheel)
• Ischemic heart disease, because if the ventricular muscle dies then it can’t stretch as easily
• Constrictive pericarditis (like the super tight wrapping on the heart-shaped present)

Question 10

Systolic heart failure is associated with increased ____-load.

Answer 10

pre (like the groomsman PULLING –Sketchy’s symbol for preload –the groom back to the wedding)

Question 11

Volume overload leads to what kind of hypertrophy?

Answer 11

Eccentric (like the eccentric eel in the sea with the LONGER sequence of myocytes beneath the groom)

Question 12

Diastolic failure is associated with increased ______-load.

Answer 12

after (like the bride getting PUSHED by the bridesmaid)

Question 13

_________________ causes concentric hypertrophy.

Answer 13

Diastolic heart failure (like the thick, stacking shells beneath the bride)

Question 14

True or false: restrictive cardiomyopathy presents with decreased chamber size.

Answer 14

False. Restrictive cardiomyopathy presents with a normal-appearing heart that is just stiffer.

(Sketchy tries to show this with the heart bow that is proportionally normal.)

Question 15

ANP and BNP are released by the atria and ventricles, respectively, in response to volume overload. What effects do these mediate?

Answer 15

• Natriuresis with decreased preload (like the peanuts thrown by the escaping groomsman)
• Arteriolar dilation (like his dilated sleeves)
• Decreased renin and aldosterone levels (like how the guy is falling with the renin rain umbrella)
• Increased GFR through efferent arteriole constriction (like the groomsman pinching his straw next to the Ground Filter Rate coffee machine)

Question 16

How does the body respond to heart failure?

Answer 16

• The body senses low cardiac output and increases the sympathetic response (like the low output boat engine next to the alligator scaring the waiter). This increases contractility and artery constriction (like the twisted sleeves of the scared waiter’s coat).
• In response to decreased CO the body also up-regulates the RAAS system (like the guy with the renin umbrella and red suspenders). This increases afterload.
• Increased ADH secretion in response to decreased cardiac output (guy pouring the ADH jug on the low output engine).

Question 17

What is meant by “deleterious cardiac remodeling”?

Answer 17

Changes in myocytes that lead to DCM or hypertrophic cardiomyopathy