Heart Failure

Question 1

Cardiomyopathy: Definition

Answer 1

disease that affect the myocardium
LEADS TO HEART FAILURE

Question 2

Cardiomyopathy: Causes (8)

Answer 2

usually idiopathic
ischemia
HTN
inherited disorders
infections
toxins
myocarditis
auto-immune condition

Question 3

Cardiomyopathy: Types (3)

Answer 3

1. dilated cardiomyopathy
2. hypertrophic cardiomyopathy
3. restrictive cardiomyopathy (amyloid)

Question 4

Heart Failure (HF): Definition

Answer 4

A chronic, progressive condition in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen
–> basically, the heart can’t keep up with its workload

Question 5

HF: Some Patho

Answer 5

myocardium is weakened—> pump is insufficient to pump blood forward and can’t meet the body’s demands

*MOST common cause oof hospitalization

Question 6

Cardiac Output is?

Answer 6

decreased with HF

Question 7

Factors determining Cardiac Output (2)

Answer 7

heart rate
stroke volume

*Cardiac Output= stroke volume x heart rate

Question 8

Factors that Affect Stroke Volume (3)

Answer 8

1. preload (amount of volume in left ventricle before it squeezes)
2. afterload (the pressure the heart has to squeeze against when it contracts)
3. myocardial contractility (pump muscle)

Question 9

HF results in? (4)

Answer 9

1. decreased cardiac output
2. decreased myocardial contractility
3. increased preload
4. increased afterload

Question 10

HF: Development (Patho Changes)

Answer 10

volume OVERLOAD–> IMPAIRED ventricular filling–> WEAKENED ventricular muscle–> DECREASED ventricular contractile function

Question 11

When does the heart fill?

Answer 11

diastole

Question 12

When does the heart contract?

Answer 12

systole

Question 13

HF: Etiology: MAJOR Causes (7)

Answer 13

-REPEATED ISCHEMIC EPISODES- ischemic cardiomyopathy
-myocardial infarction– papillary muscle rupture
-chronic HTN
-COPD (RVF)
-Dysrhythmias
-Valve disorders; mitral insufficiency, aortic stenosis
-pulmonary embolus (RVF)

Question 14

HF: MAJOR Risk Factors (9)

Answer 14

-age (increases with age, most common reason for hospitalization in ages >65)
-ethnicity (Black/African Americans are at a higher risk than Caucasians)
-family history and genetics
-diabetes
-ischemic heart disease
-obesity
-HTN
-smoking
-sedentary lifestyle

Question 15

HF: Other Risk Factors (8)

Answer 15

-within 6 months of MI
-22% men
-46% women
-men and postmenopausal women have same risk
-COPD
-severe anemia
-congenital heart defects
-viruses (certain viral infections can cause myocarditis)
-alcohol abuse/drug abuse
-kidney conditions
-excess blood volume,
edema, and
accumulation of
nitrogenous waste
(weakens the heart)

Question 16

Which is considered the GREATEST risk factor for HF?

Answer 16

HTN
Diabetes can also contribute

Question 17

What hormone is cardioprotective?

Answer 17

estrogen
believed to be why men are typically more common for HF in younger ages until women are post-menopause

Question 18

HF: Classifications (2)

Answer 18

left sided vs. right sided

Question 19

Left sided HF: Characteristics (4)

Answer 19

-congestion in LEFT chambers
-LV increases in size (LVH)
-backflow into PULMONARY VEINS
-congestion in LUNGS

*LEFT=LUNGS

Question 20

Left sided HF: Symptoms (10)

Answer 20

cough
crackles
wheezes
frothy sputum (may be blood tinged)
paroxysmal nocturnal dyspnea (PND)
orthopnea
restlessness
confusion
tachycardia
fatigue

Question 21

Right sided HF: Characteristics (5)

Answer 21

-congestion in RIGHT chambers
-RV increases in size (RVH)
-backflow into VENA CAVA, decreased to the lungs
-congestion in JUGULAR VEINS, LIVER, LOWER extremities

*RIGHT=BODY

Question 22

Right sided HF: Symptoms (9)

Answer 22

jugular vein distention (JVD)
dependent edema
weight gain
hepatosplenomegaly
fatigue
ascites
anorexia
GI distress
increased peripheral venous pressure

Question 23

What is the MOST common cause of LEFT sided HF?

Answer 23

poorly controlled HTN

Question 24

What is the MOST common cause of RIGHT sided HF?

Answer 24

COPD

Question 25

HF: Reduced Ejection Fraction (HFrEF) (Systolic HF): Definition

Answer 25

Determined by patient's EF: EF < 40%

Question 26

HF: Reduced Ejection Fraction (HFrEF) (Systolic HF): Caused by (4)

Answer 26

IMPAIRED contractile function increased afterload cardiomyopathy mechanical problems

Question 27

HF: Reduced Ejection Fraction (HFrEF) (Systolic HF): Patho

Answer 27

left ventricle loses ability to generate pressure to eject blood--> weakened muscle cannot generate stroke volume and then lowers CO--> LV fails, blood backs up, and causes fluid backup and accumulation

Question 28

HF: Preserved Ejection Fraction (HFpEF) (Diastolic HF): Definition

Answer 28

inability of the ventricles to relax and fill during diastole EF is normal or only moderately decreased (40-49%)

Question 29

HF: Preserved Ejection Fraction (HFpEF) (Diastolic HF): Cause/Risk Factors (4)

Answer 29

HTN is the primary cause female older age diabetes obesity

Question 30

HF: Preserved Ejection Fraction (HFpEF) (Diastolic HF): Patho

Answer 30

LV is stiff and noncompliant leading to high filling pressures--> leads to decreased stroke volume and decreased cardiac output--> reduced CO leads to fluid congestion

Question 31

Chronic vs. Acute HF

Answer 31

progressive chronic + episodes of "decompensated" HF -new or worsening s/s -frequent visits to the ER -hospitalization -less common- new onset HF (20%)

Question 32

Ventricular Remodeling in HF

Answer 32

a weakened heart muscle -secretion of molecular substances -angiotensin II, aldosterone, endothelin, TNF-alpha, catecholamines, insulin- like growth factor, and growth hormone -provoke genetic changes, apoptosis, and hypertrophy of cardiac myocytes, as well as collagen deposits and myocardial fibrosis these molecules cause changes lead to ENLARGEMENT AND DILATION OF THE LEFT VENTRICLE -WORSENS HF

Question 33

What murmur is common in HF?

Answer 33

S3 Gallop

Question 34

S3 Gallop

Answer 34

-low-pitched sound heard after S2 -during rapid filling of ventricle in the early part of diastole -high ventricular end-diastolic volume -increased pressure w/in ventricles

Question 35

S3 is abnormal and indicative of HF in adults of what age?

Answer 35

older than 40