heart failure

Question 1

define ejection fraction

Answer 1

SV/ EDV

Question 2

heart failure definition

Answer 2

clinical syndrome caused by the inability of the heart to supply blood to the tissues sufficient to meet their metabolic needs or achieved at the expense of elevated filling pressures

Question 3

what are the key consequences of heart failure

Answer 3

inability to keep up with demands
inadequate perfusion of organs
congestion in lungs and legs
collection of signs and symptoms

Question 4

type of heart failure

Answer 4

L vs R
Chronic vs acute
HFrEF vs HFpEF

Question 5

describe Left heart failure

Answer 5

dysfunction associated with the left ventricle
ejection or filling issue
blood backs up into the lungs causing congestion
breathlessness, coughing, wheezing- ‘respiratory symptoms’ - also dizziness and cyanosis

Question 6

describe Right heart failure

Answer 6

dysfunction associated with the right ventricle
ejection or filling issue
increased afterload of the pulmonary circulation (pulmonary hypertension)

often secondary to left heart failure

Question 7

acute vs chronic heart failure

Answer 7

chronic HF:
slow onset
infection, pulmonary embolism, myocardial infarction or surgery

acute HF:
rapid onset
symptoms similar to chronic HF, except the timing of onset and worsening is much more severe

Question 8

HF with reduced ejection fraction

Answer 8

HF with reduced EF
Abnormal systolic function
Impaired contraction of the ventricles which despite an increase in HF results in decreased cardiac output
Typically, weakness is caused by damaged or destruction of the ventricular myocytes

Question 9

HF with preserved ejection fraction

Answer 9

HF with preserved EF
Abnormal diastolic function
Normal contraction of the ventricle
Increased stiffness of the ventricle, impaired relaxation or impaired filling
Because EDV is inherently reduced, the reduced stroke volume is masked when looking at ejection fraction

Question 10

valve disease

Answer 10

hardening of the valve reduces ventricular filling (AV) or ejection (semilunar)

Question 11

IHD

Answer 11

narrowing of coronary arteries cause ischaemia in heart muscle

Question 12

Myocardial infarction

Answer 12

significant occlusion leads to death of heart muscle

Question 13

hypertension

Answer 13

hypertension increases afterload which means ventricle must work harder

Question 14

dilated cardiomyopathy

Answer 14

dilated LV reduces generatable pressures which reduces ejection

Question 15

hypertrophic cardiomyopathy

Answer 15

increased LV thickness reduces internal ventricular volume and impedes filling

Question 16

raised jugular venous pressure

Answer 16

increased pressure in right side of heart leads to pressures backing up into systemic veins, especially visible in jugular vein

Question 17

pitting oedema

Answer 17

fluid accumulation in tissues leads to pitting effect when physically depressed. The indentation is visible for a short period

Question 18

ascites

Answer 18

fluid accumulation in peritoneal cavity

Question 19

B-type natriuretic BNP

Answer 19

Natriuresis is sodium excretion
released from ventricular myocytes in response to stretch

leads to:

• vasodilation of microvessels
• reduced aldosterone secretion
• reduced sodium absorption
• inhibits renin secretion

leads to:

• reduced ECF
• reduced pressure

Question 20

treatment

Answer 20

new HF diagnosis
start ACE inhibitor
add beta blocker
add spironolactone

Question 21

what do diuretics and ACE inhibitors do?

Answer 21

reduce the load

Beta blockers reduce the speed, which saves energy and makes it easier

Question 22

non-pharmacological treatment

Answer 22

fluid control
devices
surgical

Question 23

law of laplace

Answer 23

pressure and volume govern cardiac function

Question 24

neuronal and hormonal changes

Answer 24

see slides