HF 2

Question 1

Heart Failure Classifications

Answer 1

RIght or left side

Question 2

Left Sided HF

Answer 2

Blood backs up in pulmonary circulation (left atrium first)

Question 3

Right Sided HF

Answer 3

Blood backs up in systemic circulation (right atrium first)

Question 4

Left Sided HF: Symptoms

Answer 4

• Congestion in LEFT chambers
• LV becomes larger (LVH)
• Backflow into pulmonary veins
• Congestion in lungs

Question 5

Left Sided HF: Findings

Answer 5

• Cough, crackles, wheezes
• Frothy sputum, may be blood tinged (PE)
• Paroxysmal nocturnal dyspnea (smothered and coughing at night suddenly)
• Orthopnea (tripod position to breath) (sleep sitting up)

Question 6

Right Sided HF: Symptoms

Answer 6

• Often due to COPD
• Congestion in RIGHT chambers
• RV becomes larger (RVH)
• Backflow into Vena Cava, decreases perfusion to lungs
• Congestion in jugular veins, Liver, Lower extremities

Question 7

Right Sided HF: Findings

Answer 7

JVD
Dependent Edema (swelling in lower extremities)
Weight gain
Hepatosplenomegaly

Question 8

Left-Sided HF most common cause

Answer 8

Poorly controlled HTN

LUNGS

Question 9

Right-Sided HF most common cause

Answer 9

COPD
-Pulmonary hypertension
(BODY)

Question 10

Ejection Fractions

Answer 10

The amount of blood pumped out by LEFT VENTRICAL with each squeeze (55-65%)

Question 11

HF: Reduced Ejection Fraction (HFrEF) [Systolic HF]

Answer 11

Determined by EF < 40%

Caused by:

1. Impaired contractile function
2. Inc afterload
3. Cardiomyopathy
4. Mechanical problems

• Left ventricle loses ability to generate pressure to eject blood
• Weakened muscle cannot generate stroke volume and then lowers cardiac output
• LV fails, blood backs up, causes fluid backup and accumulation

Question 12

HF: Preserved Fraction (HFpEF) [Diastolic HF]

Answer 12

Inability of ventricles to relax and fill during diastole

HTN is the primary cause

Being female, older, diabetes, and obesity are risk factors
(FOOD)

LV is stiff and noncompliant leading to high filling pressures, leads to decreased stroke volume and decreased cardiac output

Reduced CO leads to fluid congestion

EF is normal or moderately reduced

Question 13

Chronic HF

Answer 13

Episodes of “decompensated” HF

• New or worsening signs/symptoms
• Frequent visits to the ER
• Hospitalization
• Less common- new onset of HF (20%)

Question 14

Ventricular Remodeling in HF

Answer 14

A weakened heart muscle
-Secretion of molecular substances
-Angiotensin II, aldosterone, endothelin
TNF-alpha, catecholamines, insulin-like
growth factor, and growth hormone.
-Provoke genetic changes, apoptosis and hypertrophy of cardiac myocytes, as well as collagen deposits and myocardial fibrosis

These molecules cause changes that lead to ENLARGEMENT AND DILATION OF THE LEFT VENTRICLE
-Worsens HF

Question 15

S3 gallop in HF

Answer 15

• Low pitched sound heard after s2
• During rapid filling of the ventricle in the early part of diastole
• High ventricular end-diastolic volume
• Increased pressure within ventricles

Question 16

In adults older than 40 an S3 is…

Answer 16

Abnormal and indicative of HF