Heart Failure Clinical

Question 1

the ventricular wall tension t the end of diastole

Answer 1

preload

Question 2

what does dehydration or hemorrhage lead to?

Answer 2

decrease in EDV ad decrease in cardiac output

Question 3

what does increase IV infusion lead to?

Answer 3

increased volume and increased EDV increase in cardiac output

Question 4

what is after load?

Answer 4

ventricular wall tension during contraction

Question 5

an increase in after load results in what

Answer 5

decrease in cardiac output

Question 6

inotropic state is what?

Answer 6

contractility

Question 7

this is the property of heart muscle that accounts for changes in strength of contraction independent of the preload and afterload

Answer 7

contractility

Question 8

an increase in contractility results in

Answer 8

an increase in cardiac output

Question 9

what is the equation for stroke volume

Answer 9

end diastolic volume - end systolic volume

Question 10

what is the equation of ejection fraction

Answer 10

stroke volume/end diastolic volume

Question 11

what is the equation for cardiac output

Answer 11

stroke volume x heart rate

Question 12

what are the 2 scenarios that increase after load resulting in heart failure

Answer 12

advanced aortic stenosis

uncontrolled severe hypertension

Question 13

what are the 3 scenarios that impair contractility

Answer 13

coronary artery disease, chronic volume overload, dilated cardio myopathy

Question 14

increased after load and impaired contractility result in what?

Answer 14

reduced ejection fraction (systolic dysfunction)

Question 15

what are the 5 impaired diastolic filling scenarios

Answer 15

left ventricular hypertrophy, restrictive cardiomyopathy, myocardial fibrosis, transient myocardial ishcemia, pericardial constriction or tamponad

Question 16

what percent of patients with heart failure have preserved ejection fraction?

Answer 16

one half of the patients

Question 17

what are clinical symptoms of left sided heart failure

Answer 17

Systemic BP effects: dyspnea, orthopnea, nocturnal cough, fatigue, diaphoresis, tachycardia, loud P1, s3, s4 sounds

Question 18

what are clinical symptoms of left sided heart failure

Answer 18

venous BP effects: peripheral edema, hepatomegaly, anorexia, JVD, hepatomegaly

Question 19

most common cause of right sided heart failure

Answer 19

left sided heart failure

Question 20

what is the result of chronic pulmonary disease

Answer 20

isolated right heart failure

Question 21

pulmonary embolism and 1st degree pulmonary hypertension can be caused by what?

Answer 21

right sided heart failure

Question 22

patient has a pulmonary artery stenosis what kind of heart failure are they most likely to have?

Answer 22

right heart failure

Question 23

this class has no limitation of physical activity

Answer 23

class 1

Question 24

this class has a slight limitation of activity , dyspnea and fatigue with moderate exertion

Answer 24

class 2

Question 25

this class has marked limitation of activity dyspnea while walking upstairs SLOWLY

Answer 25

class 3

Question 26

this class has severe limitation of activity - symptoms are present even at rest

Answer 26

class 4

Question 27

can you switch classes according the NYHA

Answer 27

yes

Question 28

can you switch stages?

Answer 28

no

Question 29

stage A

Answer 29

risk of developing heart failure but has not developed structural cardiac dysfunction

Question 30

Stage B

Answer 30

has structural heart disease associated with heart failure but not had symptoms

Question 31

stage c

Answer 31

has symptoms associated with structural heart disease

Question 32

stage d

Answer 32

has structural heart disease and marked heart failure despite medical therapy and intervention

Question 33

what can you expect to see on chest radiography of heart failure

Answer 33

kerley B lines, upper zone vascular redistribution, cardiomegaly, enlarged azygous

Question 34

what lab study should you do ?

Answer 34

assay for BNP indicatory of LV dysfunction

Question 35

what is the prognosis for class III

Answer 35

1 year 40%

Question 36

what do most patients die suddenly of?

Answer 36

ventricular arrythmias

Question 37

increased TNF alpha, Btype natruretic peptide, RAA system mediators are indicative of what?

Answer 37

poor prognosis

Question 38

when should you use diuretics?

Answer 38

preserved EF treatment goals (impaired diastolic filling)

Question 39

when are beta blockers appropriate?

Answer 39

heart failure due to augmented CO, decreased HR and decreased sympathetic effects at heart

Question 40

when are beta blockers inappropriate

Answer 40

- systolic dysfunction due to negative ionotropic effects

Question 41

what is cardiac resynchronization therapy

Answer 41

simultaneous biventricular pacing, achieved through a pacemaker

Question 42

What are the 3 qualities that candidates for CRT have?

Answer 42

LV dysfunction EF , 35%, prolonged QRS (LBBB), meds not helping