CHF

Question 1

What is cardiac output?

Answer 1

amount of blood left in the ventricle

Question 2

What is cardiac preload?

Answer 2

Pressure in the right side of the heart as blood returns to the heart

Question 3

What is cardiac afterload?

Answer 3

Pressure the heart must pump against within the arterial system to eject blood (Peripheral vascular resistance)

Question 4

At the hemodynamic level, what causes impaired contractility?

Answer 4

Loss of cardiac muscle cells, Beta receptor down-regulation, and reduced ATP production

Question 5

Systolic Dysfunction

Answer 5

Is usually the result of an MI. Evidenced by low ejection fraction and reduced inotropy during ventricular systole.

Question 6

Diastolic Dysfunction

Answer 6

Usually caused by HTN and IHD. Decreased myocardial noncompliant decreasing filling. Low CO with normal ejection fraction.

Question 7

Who is more likely to develop diastolic dysfunction?

Answer 7

Elderly, women, and those with a history of MI

Question 8

What favourable effect does increased sympathetic activity have?

Answer 8

Increased HR, Increased contractility, vasoconstriction causing increased venus return and filling

Question 9

What unfavourable effect does increased sympathetic activity have?

Answer 9

Arteriolar constriction, afterload,increased workload, increased O2 consumption

Question 10

What favourable effect does increased Renin-Angiotension Aldosterone have?

Answer 10

Salt and water retention, increased VR

Question 11

What unfavourable effect does increased Renin-Angiotension Aldosterone have?

Answer 11

Vasoconstriction causing increased afterload

Question 12

What favourable effect does increased IL-1 and TNF-Alpha have?

Answer 12

May have roles in myocyte hypertrophy and LV remodeling

Question 13

What unfavourable effect does IL-1 and TNF-Alpha have?

Answer 13

Apoptosis

Question 14

What favourable effect does increased endothelin have?

Answer 14

Vasoconstriction causing increased VR

Question 15

What unfavourable effect does increased endothelin have?

Answer 15

Increased afterload

Question 16

What are the BACKWARD effects of LVF?

Answer 16

dyspnea on exertion, orthopnea, cough, paroxysmal nocturnal dyspnea, cyanosis, basilar crackles

Question 17

What are the FORWARD effects of LVF?

Answer 17

Fatigue, oliguria, increased heart rate, faint pulses, restlessness, confusion, anxiety

Question 18

What are the BACKWARD effects of RVF?

Answer 18

Hepatomegaly, ascites, splenomegaly, anorexia, subcut edema, jugular vein distention

Question 19

What are the FORWARD effects of RVF?

Answer 19

Fatigue, oliguria, increased heart rate, faint pulses, restlessness, confusion, anxiety

Question 20

How many classes of heart failure are there according to the NYHA?

Answer 20

4

Question 21

Class 1 of heart failure

Answer 21

no limitation. Normal physical exercise does not cause fatigue, dyspnoea or palpatations.

Question 22

Class 2 of heart failure

Answer 22

Mild limitation. Comfortable at rest but normal physical activity produces fatigue, dyspnoea or palpatations

Question 23

Class 3 of heart failure

Answer 23

Marked limitation. Comfortable at rest but less gentle physical activity produces marked symptoms of heart failure.

Question 24

Class 4 of heart failure

Answer 24

Symptoms of heart failure occur at rest and are exacerbated by any physical activity

Question 25

What is a diagnosis of CHF based upon?

Answer 25

Past medical history, physical examination, laboratory and radiologic findings

Question 26

What does a blood test use to diagnose CHF?

Answer 26

CBS, Liver biochemistry, cardiac enzymes, BNP, and thyroid function

Question 27

How does echocardiography diagnose CHF?

Answer 27

It establishes the presence of systolic and/or diastolic impairment of the left or right ventricle to determine the EF.

Question 28

Importance of Brain Natriuretic Peptide in CHF

Answer 28

The hormones pro-BNP and BNP are highly accurate for identifying or excluding HF with high specificity and sensitivity. Particularly valuable in differentiating cardiac from pulmonary causes of dyspnea.

Question 29

What is the Major Framingham Criteria for diagnoses of CHF?

Answer 29

PND, Neck vein distention, rales, cardiomegaly, acute pulmonary edema, S3 gallop, increased venous pressure, and positive hepatojugular reflux

Question 30

What is the minor Framingham criteria for diagnoses of CHF?

Answer 30

Extremity edema, night cough dyspnea on exertion, hepatomegaly, pleural effusion, vital capacity reduced by 1/3 from normal, tachycardia (>120 bpm). Weight loss > 4.5kg over 5 days of treatment.

Question 31

To establish a clinical diagnosis of CHF using the Framingham criteria a patient must exhibit...

Answer 31

at least one major or two minor criteria are required.

Question 32

Beta blockers in CHF should be used if

Answer 32

stable and no fluid overload.

Question 33

How does a beta blocker work on CHF?

Answer 33

Makes you feel weak and tired for a few days then stable. Reduce HR and BP through SNS to decrease consumption of O2 of the heart muscle

Question 34

What do ACE inhibitors/ ARBS do in CHF

Answer 34

Vasodilate, counteract RAAS

Question 35

When should you use a diuretic in CHF?

Answer 35

If volume is overloaded. It decreases preload, blood pressure and edema

Question 36

What does digoxin do in CHF?

Answer 36

Decreases HR and enhances contractility

Question 37

When should you use Aldactone and what does it do?

Answer 37

You should use aldactone if you are still symptomatic and have low K+. It decreases Na retention.

Question 38

Non-pharm measures for CHF

Answer 38

Moderate aerobic exercise Sodium restriction (2-3g/day, 1-2g if advanced HF) 1.5-2L of fluid/day Daily weighing Flu and pneumonia vaccines Close supervision and follow-up