heart failure

Question 1

Heart failure is the

Answer 1

inability of the heart to pump blood forward at a sufficient rate to meet the metabolic demands of the body (forward failure), or the ability to do so only if the cardiac filling pressures are abnormally high (backward failure)

Question 2

HR is a

Answer 2

syndrome describing a constellation of signs and symptoms caused by many possible abnormalities of heart function

Question 3

Poor FORWARD blood flow is a

Answer 3

1. key requirement of HF

2. LOW FLOW (↓ cardiac output)

Question 4

BACKWARD buildup of pressure

Answer 4

1. is almost always present as well
2. CONGESTION (↑ filling pressures)
3. Typically a response to low flow

Question 5

____ determines dysfunction

Answer 5

function

Question 6

dysfunction: Displacement pumps

Answer 6

1. Squeeze (contraction)
2. Fill (relaxation)
3. Failure of either systole or
4. diastole causes HF

Question 7

dysfunction: 2x pumps

Answer 7

left and right in series

Left, right, or both can fail

Question 8

dysfunction: Coordinated by an

Answer 8

1. electrical system

2. Too slow, too fast, asynchronous … all ↓ efficiency

Question 9

dysfunction: Directed by

Answer 9

1. 4x valves

2. Regurgitation (backflow) or stenosis (resistance) stress heart

Question 10

dysfunction: Supplied by

Answer 10

1. coronaries
2. Regurgitation (backflow) or
3. stenosis (resistance) stress heart

Question 11

dysfunction: Encased in

Answer 11

1. pericardium
2. Regurgitation (backflow) or
3. stenosis (resistance) stress heart

Question 12

key mediators of blood flow

Answer 12

1. intropy
2. preload
3. afterload
4. stroke volume
5. heart rate
6. cardiac outpuut

Question 13

Ventricular output increases in relation to

Answer 13

greater filling

Question 14

Inotropy =

Answer 14

contractility

Question 15

The more the LV is filled, the more it

Answer 15

will contract

Question 16

↑ Preload produces

Answer 16

increased SV (and thus CO) for the same inotropic state

Question 17

Same filling (preload) of LV produces a

Answer 17

greater squeeze of contraction

Question 18

Determinants of inotropy

Answer 18

1. Catecholaminergic / adrenergic stimulation

2. Calcium

Question 19

↑ Inotropy produces increased

Answer 19

SV (and thus CO) for the same level of preload

Question 20

↑ Preload cause ___ SV

Answer 20

(↑ SV)

Question 21

↑ Inotropy causes ___ SV

Answer 21

(↑ SV)

Question 22

↑ Afterload causes ___ SV

Answer 22

(↓ SV)

Question 23

Weak / damaged myocardium = ___ failure

Answer 23

systolic

Question 24

Systolic dysfunction

Answer 24

1. problem with squeeze
2. ↓contraction / ↓ inotropy
3. ↓ SV
4. lower generated systolic BP

Question 25

hallmark of systolic dysfunction is

Answer 25

1. Decreased ejection fraction | 2. Ventricular enlargement

Question 26

Ventricular enlargement

Answer 26

“dilated cardiomyopathy” = DCM

Question 27

Decreased ejection fraction

Answer 27

1. “HF with reduced ejection fraction” = HFrEF | 2. “left ventricular systolic dysfunction” = LVSD

Question 28

Primary causes of systolic HF

Answer 28

``` 1. Direct destruction of heart muscle cells Myocardial infarction Viral myocarditis Peripartum cardiomyopathy Ideopathic dilated cardiomyopathy Alcohol 2. Overstressed heart muscle 3. Volume overloaded heart muscle ```

Question 29

Overstressed heart muscle | can be cause by

Answer 29

1. Tachycardia-mediated HF 2. Methamphetamine abuse 3. Stress-provoked (tako-tsubo cardiomyopathy)

Question 30

Volume overloaded heart muscle can be caused by

Answer 30

1. Mitral regurgitation 2. High cardiac output 3. Shunting of blood 4. Wet beriberi (thiamine B1 deficiency)

Question 31

Direct destruction of heart muscle cells | can be caused by?

Answer 31

1. Myocardial infarction 2. Viral myocarditis 3. Peripartum cardiomyopathy 4. Ideopathic dilated cardiomyopathy 5. Alcohol