Heart Failure

Question 1

Definition

Answer 1

inability of heart to pump sufficient blood to meet needs of the body

Question 2

Most common hemodynamic disorder

Answer 2

Heart failure

Question 3

Prevalence

Answer 3

Rises sharply in old age (80 and older especially)

Most common in older women

AA prevalence is 25% higher than caucasians

Question 4

Most common STRUCTURAL correlate to Heart failure (Heart Failure is a Functional syndrome)

Answer 4

MI

Question 5

Risk factors

Answer 5

1. CAD
2. Smoking
3. HTN
4. Overweight
5. Diabetes mellitus
6. Valvular Heart Disease

Question 6

Acute HF or Chronic HF more common?

Answer 6

Chronic

Question 7

Most frequent cause of Chronic HF

Answer 7

old MIs (usually multiple)…“ischemic cardiomyopathy”

Question 8

Causes of acute HF

Answer 8

• -CAD

- -acute MI or even acute myocardial ischmia that isn’t an infarction yet

Question 9

Cause of HF…impaired contractility

Answer 9

CAD

Question 10

Cause of HF…excessive afterload (exceeding ability of heart to compensate)

Answer 10

Severe hypertension

Stenosis of the aortic valve

Question 11

Causes of HF that lower ejection fraction

Answer 11

aortic stenosis
severe hypertension (Decompensated)
CAD

Question 12

Causes of HF that usually preserve the ejection fraction

Answer 12

**Compensated HTN
left ventricular hypertrophy
resstrictive cardiomyopathy
pericardial disease
Sometimes transient myocardial ischmia
--if impairs O2 and nutrient delivery needed for early diastolic relaxation

Question 13

Typical signs of HF

Answer 13

• -cardiomegaly (dilation of the chambers rather than thickening of the walls…exacerbates problem b/c increases stress)
• -

Question 14

Most common symptom of HF

Answer 14

dyspnea

Question 15

When pulmonary venous pressure goes from 8 to 20mmHg…

Answer 15

transudate passes from veins to interstitium…

interstitial edema compresses bronchioles and alveoli

Question 16

HF presentation

Answer 16

dyspnea
Paroxysmal nocturnal dyspnea (PND)
orthopnea (dyspnea w/ laying down)
fatigue
weakness

Question 17

Two most specific symptoms of HF

Answer 17

PND

orthopnea

Question 18

Two most common symptoms of HF

Answer 18

Dyspnea

Fatigue

Question 19

Signs of HF

Answer 19

tachycardia
tachypnea
Hypotension
pulmonary crackles
pulmonary wheezing
diaphoresis
gallops
Dulled mental status
oliguria

Question 20

Pulmonary crackles are associated w/…

Answer 20

pulmonary alveolar edema

Question 21

When pulmonary venous pressure goes over 25mmHg…

Answer 21

transudate passes into interstitium AND airspace, as the junctions b/w capillary endothelial and alveolar lining epithelial cells are pulled open by pressure

Question 22

crackles

Answer 22

• -inspiratory sounds
• -attributed to popping open of small airways occluded by edema b/w inspirations

–first heart at lung bases (where vascular hydrostatic pressure is highest)

Question 23

Cardiac asthma

Answer 23

wheezing due to edema around large airways

Question 24

Diaphoresis is sign of HF due to…

Answer 24

sympathetic nervous stimulation…a compensatory response

Question 25

When is S3 heard?

Answer 25

early diastole

Question 26

How does S3 sound?

Answer 26

dull, low-pitched

“Kentucky”

Question 27

What causes S3?

Answer 27

rapid filling

Question 28

Is S3 always pathologic?

Answer 28

no…can be normal in children and young adults

Question 29

Diagnosis of HF

Answer 29

Hx
Physical
CXR
echocardiography

Question 30

CXR findings

Answer 30

cardiomegaly
pulmonary vascular congestion
interstitial or alveolar edema

Question 31

echocardiography

Answer 31

can be diagnostic

estimate of ejection fraction

Question 32

What correlates w/ severity of HF?

Answer 32

EF

levels of BNP

Question 33

compensatory mechanisms for heart failure?

Answer 33

increased BNP secretion

Question 34

How do we differentiate dyspnea/pulmonary edema due to lung disease from HF?

Answer 34

• -elevated BNP levels=HF

- -

Question 35

serum B-type natriuretic peptide

Answer 35

biomarker of HF