Gen Med: Lecture 8- CHF

Question 1

What is the Frank Starling relationship?

Answer 1

Stroke volume related to ventricular end diastolic volume

Question 2

What happens if end diastolic volume is too high?

Answer 2

Stroke volume goes down

Question 3

What 3 factors affect stroke volume?

Answer 3

Contractility
Preload
Afterload

Question 4

How does stroke volume increase during exercise?

Answer 4

Increased venous return increase preload

Question 5

In heart failure, how does the Frank Starling relationship shift and what does it cause?

Answer 5

Shift to the right
Causes higher back pressures in lungs and periphery

Question 6

What effects does the activation of Beta Receptors have?

Answer 6

Increase contractility
Increase HR

Question 7

What does excess stimulation of the Beta Receptors cause?

Answer 7

Arrhythmias

Question 8

What compensatory mechanisms are active in heart failure to make up for decreased CO?

Answer 8

Increased sympathetic hormones
Activation of RAA system

Question 9

Why are the compensatory mechanisms in heart failure dangerous?

Answer 9

Promote myocyte apoptosis leading to hypertrophy, loss of myocytes, and fibrosis

Question 10

What type of heart failure is considered a systolic dysfunction?

Answer 10

Left ventricular heart failure with reduced ejection fraction

Question 11

What type of heart failure is considered a diastolic dysfunction?

Answer 11

Left ventricular heart failure with preserved ejection fraction

Question 12

What causes systolic dysfunction heart failure?

Answer 12

Diminished ability to pump blood requiring increased filling pressures to meet demands of metabolic tissues like muscles

Question 13

What types of symptoms does systolic dysfunction lead to?

Answer 13

Peripheral edema
Pulmonary edema
SOB
Weakness
Fatigue

Question 14

Why does left sided heart failure with reduced ejection fraction/systolic dysfuction cause peripheral edema?

Answer 14

Increased RAA

Question 15

What can left sided heart failure often lead to?

Answer 15

Right sided congestive heart failure

Question 16

What will be found on a physical exam indicative of Heart failure with reduced ejection fraction/systolic dysfunction?

Answer 16

S3
Rales/crackles on lung exam
Peripheral edema

Question 17

How would Heart failure with reduced ejection fraction/systolic dysfunction show on a chest x ray?

Answer 17

Pulmonary vascular congestion
Enlarged heart
Pulmonary edema

Question 18

What may show up on labs in someone with heart failure with reduced ejection fraction/systolic dysfunction?

Answer 18

Hyponatremia
BNP

Question 19

What shows up on an ECHO in someone with heart failure with reduced ejection fraction/systolic dysfunction?

Answer 19

Reduced ejection fraction

Question 20

What are the most common causes of heart failure with reduced ejection fraction?

Answer 20

Coronary Heart disease
Dilated cardiomyopathy
Hypertension
Valvular disease

Question 21

What are the guidelines for using beta blockers to treat congestive heart failure?

Answer 21

Do not use them in acute uncompensated CHF
Initiate use once CHF is compensated

Question 22

What is the primary goal in the treatment of HFrEF?

Answer 22

Manage hypertension, myocardial ischemia, and diabetes

Question 23

What is the preferred methods of treatment for hypertension in people with HFrEF?

Answer 23

B-Blockers (Only in compensated CHF)
ACE
ARB
Mineral corticoids

Question 24

What medications can be used as alternatives to treat hypertension in people with HFrEF if tradition meds don’t work?

Answer 24

Loop diuretics
Hydralazine
Calcium Channel Blockers

Question 25

What medication is used to treat volume overload in people with HFrEF?

Answer 25

Loop diuretics

Question 26

How is coronary disease determined?

Answer 26

With heart catheterization

Question 27

What can an ECHO be used to assess for in people with HRrEF?

Answer 27

Valvular disease

Question 28

What are some lifestyle modifications for people with HFrEF?

Answer 28

Quit smoking Control LDL Restrict Alcohol Restrict Sodium

Question 29

What associated conditions should be treated in people with HFrEF?

Answer 29

A-Fib Ventricular Arrhythmias Thromboembolism

Question 30

What medications have been found to improve symptoms in people with HFrEF?

Answer 30

Diuretics B-Blockers Arni ACE ARBs Hydralazine/Nitrates Digoxin Aldosterone Antagonists

Question 31

What medications have been found to improve survival in people with HFrEF?

Answer 31

B-Blockers ACE Hydralazine/nitrates Aldosterone antagonists

Question 32

What diabetic medication has been shown to positively affect people with HFrEF?

Answer 32

SGLT2 Antagonists

Question 33

How is ejection fraction affected in individuals with HFpEF?

Answer 33

Normal

Question 34

How does the ventricle differ in individuals with HFpEF?

Answer 34

Stiff and doesn't relax properly during diastole

Question 35

What are the effects on the heart in HFpEF caused by the heart not relaxing during diastole?

Answer 35

Increased LV filling pressure

Question 36

How does an increased LV filling pressure affect other systems?

Answer 36

Increases back pressure to pulmonary vasculature

Question 37

What symptoms are caused by increased back pressure to pulmonary vasculature?

Answer 37

Dyspnea Orthopnea PND Pulmonary edema

Question 38

What are the effects on end diastolic volume in people with HFpEF?

Answer 38

Normal

Question 39

What can be found during a physical exam of someone with HFpEF?

Answer 39

S3 S4 Rales/crackles Peripheral edema

Question 40

What can be seen on chest x-ray in people with HFpEF?

Answer 40

pulmonary edema

Question 41

What labs are often different in people with HFpEF?

Answer 41

Decreased Na Increased BNP

Question 42

What can be seen on an ECHO in people with HFpEF?

Answer 42

LV Hypertrophy LA Enlargement Normal EF Elevated end diastolic pressure Elevated pulmonary artery systolic pressure

Question 43

What medications should be used to treat HFpEF?

Answer 43

Diuretics Aldosterone Antagonists ACE

Question 44

When should B-Blockers be used in people with HFpEF?

Answer 44

Only if there is associated coronary heart disease

Question 45

What are symptoms of Right Ventricular Heart Failure?

Answer 45

Hepatic congestion Ascites Peripheral edema

Question 46

What can be found during physical exam in people with right ventricular heart failure?

Answer 46

JVD Right sided S3 Liver enlargement Ascites Peripheral edema

Question 47

What can be seen on a 12 lead EKG in people with right ventricular heart failure?

Answer 47

Right axis deviation RVH Right sided strain pattern

Question 48

What can be seen on an ECHO in people with right ventricular heart failure?

Answer 48

Pulmonary hypertension Right ventricular dysfunction