Pathophysiology and Treatment Introdruction of Chronic Heart Failure

Question 1

What is heart failure

Answer 1

Clinical syndrome caused by the inability of the heart to pump enough blood to meet the metabolic demands of the body

Question 2

What are symptoms of heart failure

Answer 2

dyspnea, fatigue, fluid retention

Question 3

T/F: Heart failure will get worse if not treated or is on medication than taken off

Answer 3

True

Question 4

What is preload, afterload

Answer 4

End diastolic volume that stretches the left ventricle to the most, pressure against which the heart must work to eject blood during systole

Question 5

What ejection fraction

Answer 5

Portion of the total ventricular blood volume that is ejected during each contraction

Question 6

What is a normal ejection fraction, what is the most accurate way to find the ejection fraction

Answer 6

50% or more, echocardiogram and cardiac MRI

Question 7

What are the two types reduced ejection fraction and how are they caused

Answer 7

Heart Failure Reduced Ejection Fraction: Results from loss of muscle mass, pressure or volume overload (systolic dysfunction)/ Heart Failure preserved Ejection Fraction: Results from increased ventricular stiffness

Question 8

T/F: Any type of heart failure has a ejection fraction less than 50%

Answer 8

False: HF-Reduced has an EF less than or equal to 40% while HF-Preserved has an EF greater than or equal to 50%

Question 9

What is the most common cause of HF-Preserved

Answer 9

Left Ventricular Hypertrophy due to longstanding hypertension

Question 10

What causes HF-Reduced

Answer 10

Initial cardiac insult -> primary damage-> activation of compensatory mechanisms -> secondary damage mediated by neurohormones

Question 11

What are the two most common initial cardiac insults that could cause primary damage leading to HF-reduced

Answer 11

Myocardial infarction and Hypertension

Question 12

What are the compensatory mechanisms that can cause secondary damage mediated by neurohormones

Answer 12

Increased preload, vasoconstriction, tachycardia, ventricular remodeling

Question 13

How is compensating for cardiac output increasing the preload therefore contributing to HF-Reduced

Answer 13

Increased preload-> less cardiac output-> reduced renal perfusion-> kidney interprets this as ineffective blood volume-> activation of the RAAS system leading to H2O and NA retention: chronic volume overload and increased myocardial demand

Question 14

How is compensating for cardiac output increasing the afterload therefore contributing to HF-Reduced

Answer 14

Increased afterload-> less cardiac output-> reduced Mean Arterial Blood Pressure-> activation of the RAAS system and SNS leads to VASOCONSTRICTION: increase myocardial demand and the heart become to week to overcome

Question 15

How is compensating for cardiac output causing tachycardia that contributes to HF-REduced

Answer 15

ess cardiac output-> reduced O2 supply to tissues-> activation of SNS leads to increased HR: Decreased disatolic filling time, increased myocardial demand, precipitation of arrhythmias, down regulation of beta receptors

Question 16

What are the two hormones that contributed the most to HF-Reduced, how

Answer 16

Anigotensin II: cardiac fibrosis, Norepinephrine: myocyte necrosis (apoptosis) and down-regulation of Beta receptors (decreased inotropy/less contractility)

Question 17

What are the hormones that can aid in HF,how

Answer 17

Nitric Oxide: vasodilator, ANP (atria) and BNP (ventricles): Inhibt RAAS and SNS causing vasodilation and sodium/water loss

Question 18

What are the drug classes the are ESSENTIAL to HF-Reduced therapy

Answer 18

RAAS inhibitors and Beta-blockers

Question 19

What lab values aids in diagnosing HF

Answer 19

BNP greater than 400,

Question 20

What are heart failure symptoms suggesting backward flow (heart is too weak to push blood to the whole body and fluid/pressure accumulates)

Answer 20

Abdomial pain, bloating, nausea, early satiety, Paroxy Nocturnal Dypnea, Cough, Edema, jugular venous distension, Hepatojugular reflux, crackles in the lungs

Question 21

What are heart failure symptoms suggesting forward flow (heart is too weak to push blood to the whole body and limbs have inadequate O2 delivered

Answer 21

Exercise intolerance, faigue/weakness, dyspnea on exertion, confusion/altered mental status, tachycardia

Question 22

In hear failure assessment what are the 4 functional classes

Answer 22

I: No symptoms with ordinary activity
II: Symptoms with ordinary physical activity
III: Symptoms with ordinary daily tasks (walking/getting dressed)
IV: Symptoms at rest

Question 23

In heart failure assessment what are the 4 stages

Answer 23

A: At high risk for HF but without structural heart disease or symptoms
B: Structural heart disease (low EF) but without signs or symptoms
C: Structural heart disease with prior or current symptoms
D: Refractory HF requiring specialized interventions (end stage)

Question 24

What are treatment goals for HF

Answer 24

Relieve symptoms and improve quality of life, reduce hospitalizations, improve survival, slow disease progression

Question 25

What are patient tips to aid in the HF

Answer 25

Na restriction to 2-3 grams/day, daily weighs, fluid restriction to 2L/day, exercise, weight reduction, avoid alcohol