Heart Failure

Question 1

what is heart failure in general

Answer 1

complex clinical syndrome

dysfunction of LV, RV or both

terminal stage of heart diasease

Question 2

most characteristic symptom

Answer 2

easy fatigability

Question 3

left sided heart failure

Answer 3

L ventricle does not deliver O2 rich blood = easy fatigablity and SOB

also inc BP in BV bet lungs and L ventricle = inc pressure to force fluid and blood out lungs = SOB

Question 4

right sided heart failure

Answer 4

R ventricle in unable to contract enough to push blood into lungs

causes build up of blood in veins = edema

Question 5

most common cause of HF

Answer 5

coronary artery disease

Question 6

other causes of HF

Answer 6

high BP

DM

damage to valves

damage to heart muscle

poison or substance

lung disease

sleep apnea

Question 7

medical tx of HF

Answer 7

diuretics: reduce swelling by inc urine

ACE inhibitors: allow BV to expand and dec BP preventing further damage

beta blockers: blocks effect of stress hormones

Question 8

CABG

Answer 8

improves BF to heart muscle

Question 9

heart valve reconstruction

Answer 9

improve BF through the hear

Question 10

L ventricle reconstruction

Answer 10

remove damaged heart muscle

Question 11

implanted ventricular assists device

Answer 11

LVAD - helps to pump blood

Question 12

heart transplant

Answer 12

in extreme cases of HF

Question 13

hemodynamic adaptations - inc ventricular end-diastolic volume and pressure

Answer 13

may tira after systole hence more blood volume in diastole = heart works more

Question 14

hemodynamic adaptations - inc atrial volume and pressure

Answer 14

inc pressure on L side causes inc pressure in blood flow from R to L = more work

Question 15

hemodynamic adaptations - inc atrial and ventricular contractility

Answer 15

starling’s law - inc volume will inc stretch

heart muscle will contract more since more blood to eject

Question 16

hemodynamic adaptations - inc vol and pressure in adjacent venous system

Answer 16

dammed up IVC and SVC

neck veins and IVC engorged

liver congestion

venous congestion in LE

Question 17

hemodynamic adaptations - inc capillary pressure and secondary transudation of fluid

Answer 17

too much pressure in capillary = fluid seeps into interstitial space

Question 18

hemodynamic adaptations - inc interstitial and extracellular fulid volume

Answer 18

bipedal edema

gr 1: ankle

gr 2: knee

gr 3: thigh

gr 4: anasarca or entire body

Question 19

hemodynamic adaptations - inc lymphatic flow from interstitial spaces

Answer 19

edema anywhere on the body

Question 20

what warrants suspicion of heart failure

Answer 20

edematous from leg down

Question 21

hemodynamic adaptations present in acute and chronic HF

Answer 21

acute: not all

chronic: 1-7

Question 22

exp myocardial dysfunction and neurohormonal mechanisms

Answer 22

myocardial insult causes myocardial dysfunction

heart cannot empty inc load = reduced systemic perfusion

detected by kidneys - activation of RAS and ANS = adaptations

overly expressed RAS and ANS - growth and remodelling = ischemia or cell death in long term

Question 23

compensatory mechanisms in HF

Answer 23

adrenergic system: catecholamines will inc HR and BP

RAS: inc blood vol

vasoconstrictions: to conserve blood

all will cause damage in long term, only helpful in acute

Question 24

mechanical abnormalities in HF

Answer 24

pressure overload

volume overload

masyado madami laman sa loob di na ma pump out and may natitira

Question 25

restriction of ventricular filling in HF

Answer 25

mitral stenosis - cannot fill L ventricle constrictive pericarditis - di ma ffill kase maga less space LVH - muscle gets thick so less space to fill endomyocardial fibrosis - fibrotic tissue does not expand and contract effectively

Question 26

primary myocardial disease

Answer 26

myocardial muscle is weak congenital - duchenne's

Question 27

secondary myocardial disease

Answer 27

CAD DM - metabolic amphetamines, chemo - drugs iron deposition - metals scleroderma - CT disease neuro disease inherited disease

Question 28

common etiology

Answer 28

AMI prolonged CV stress - HTN, valve disease toxins infection idiopathic

Question 29

acute heart failure

Answer 29

1-2 wks lang tas chronic na basta wala na adaptations MC - AMI; rapid sx inadequate organ perfusion - large part of myocardium sudden cardiac decompensation CO, BP and HR go gown fast

Question 30

results if only a small part of myocardium is damaged

Answer 30

heart attack

Question 31

chronic HF

Answer 31

adaptive mech are gradually activated sx manifest mildly kaya able to adapt cardiac hypertrophy pt usually disregards and is able to adapt to sx L sided HF if disregarded can lead to R sided HF stable but can decompensate with precipitating factors

Question 32

discuss progression of HF

Answer 32

usually one sided - L biventricular in the long run: L-R R sided HF to L is rare d/t ventricular interdependence - enlarged sided compresses other side

Question 33

low output HF

Answer 33

typical HF pump failure - weak dec CO - vasoconstriction as compensation vasoconstriction - cold, clammy and pale hands - oliguria - low pulse pressure - diff of < 40 mmHg - widened O2 diff

Question 34

high ouput HF

Answer 34

normal ejection - >4L/min/m2 unable to meet metabolic demand less common assoc c hyperkinetic circulatory state - anemia, thyrotoxicosis, pregnancy, pagets, AV fistula vasodilation: warm and flushed - bounding pulse - normal or dec O2 diff

Question 35

backward HF

Answer 35

R sided HF d/t L sided HF inc pressure in L side causes backward transmission pulmonary HTN dec CO inadequate perfusion

Question 36

forward HF

Answer 36

inadequate CO in forward direction under perfusion of brain - dizzy and confuse - fatigue and weak sodium and water rentention

Question 37

systolic heart failure

Answer 37

typical pump failure d/t chronic contractile dysfunction: - myocardial necrosis - acute depression of inotropy inadequate forward CO

Question 38

diastolic HF

Answer 38

filling phase is abnormal - more subtle reduced ventricular compliance LV fibrosis acute reduction in diastolic relaxation causes pulmonary or systemic congestion

Question 39

HF ejection fractions

Answer 39

HFrEF: < 40% HFmEF: 40-49% HFpEF: > 50% normal: 55% < 50% - HF 2D Echo

Question 41

stages of HF

Answer 41

A: high risk for HF but s structural or sx B: c structural but s sx C: c structural and prior or current sx D: refractory

Question 42

clinical manifestations of HF

Answer 42

SOB PND orthopnea fatigue and weakness nocturia and oliguria edema arrhytmias

Question 43

NYHA classification

Answer 43

1: no limitation 2: slight; ordinary activity cause sx 3: marked; less than ordinary activity causes sx 4: sx at rest worsents c any activity

Question 44

exercise prescription in HF

Answer 44

usually class 1-3 mod to vigorous aerobic for 30-40 mins at 3x a wk 60-70% HRR 5-10 mins until 30 mins