Lecture 17: Heart Failure

Question 1

What is “Heart Failure?”

Answer 1

• The inability of the CO to keep pace with the body’s demands for supplies and removal of wastes
• either one or both ventricles may progressively weaken and fail

Question 2

What is majority cause of heart failure?

Answer 2

Dysfunction of the left ventricle

systolic and diastolic heart failure

Question 3

The ____ ventricle also may be dysfunctional especially in ____ disease (_____ _____ failure)

Answer 3

right

pulmonary (right ventricle)

Question 4

What are the Compensatory Measure’s first step?

Answer 4

sympathetic activity to the heart is reflexly increased

Question 5

What are the Compensatory Measure’s second step?

Answer 5

when CO is reduced, the kidneys, attempt to improve their reduced blood flow, retain extra salt and water in the body during urine formation to expand the blood volume

Question 6

What is Class I?

Answer 6

• No limitation is experienced in any activities

- no symptoms from ordinary activities

Question 7

What is Class II?

Answer 7

• Slight, mild limitations of activity

- the patient is comfortable at rest or with mild exertion

Question 8

What is Class III?

Answer 8

Marked limitation of any activity

the patient is comfortable only at rest

Question 9

What is Class IV?

Answer 9

Any physical activity brings on discomfort and symptoms occur at rest

Question 10

What is Stage A?

Answer 10

• high risk HF in future

- no symptoms at any stage

Question 11

What is Stage B?

Answer 11

• A structural heart disorder

- no symptoms at any stage

Question 12

What is Stage C?

Answer 12

• Previous or current symptoms of HF in the context of underlying structural heart problem
• managed with medical treatment

Question 13

What is Stage D?

Answer 13

• Advanced disease requiring hospital-based support

- heart transplant or palliative care

Question 14

As the disease progresses and the contractility of the heart deteriorates further, the heart reaches a point at which it is no longer able to pump out a normal Stroke Volume despite compensatory measures is called:

Answer 14

Decompensated Heart Failure

Question 15

What is Left Sided Failure?

Answer 15

Backwards failure of the left side leads to pulmonary edema because blood dams up in the lungs

Question 16

Right sided failure has more serious consequences than Left sided failure.
T/F

Answer 16

False, Left side is more serious than right

Question 17

What is “Systolic Left Heart Failure?”

Answer 17

an inability of the heart to generate an adequate CO to perfuse vital tissues

Question 18

Clinical Manifestations
The clinical manifestations of ____ heart failure are the result of ______ ________ congestion and inadequate perfusion of the _______ circulation

Answer 18

right
pulmonary vascular
sympathetic

Question 19

Clinical Manifestations

Individuals experiences:

Answer 19

• Dyspnea
• Orthopnea
• Cough of frothy sputum
• Fatigue
• Decreased Urine output
• Edema

Question 20

Decreasing _____, increasing _____ and _____, as well as blocking the ______ mediators of myocardial toxicity, this will mange systolic left heart failure.

Answer 20

contractility, preload; afterload

neurohumoral

Question 21

These 3 things improve myocardial oxygenation:

Answer 21

• Oxygen
• Nitrates
• Morphine

Question 22

These increase contractility and can help raise the blood pressure in hypotensive individuals:

Answer 22

Intravenous Inotropic drugs

Question 23

These reduce preload:

These reduce both preload and afterload by decreasing aldosterone levels and reducing PVR?

Answer 23

Diuretics

ACE Inhibitors

Question 24

This short acting drug helps reduce mortality:

Answer 24

Intravenous Beta-Blockers

Question 25

This intravenous administration of this to the brain also improves preload and contractility

Answer 25

Natriuretic peptide (Nesirtide)

Question 26

Individuals may benefit from either of these:

Answer 26

Acute Coronary Bypass | Percutaneous Coronary Intervention

Question 27

What is Acute Decompensated Heart Failure (ADHF)?

Answer 27

Worsening signs and symptoms of heart failure

Question 28

what symptoms are associated with ADHF?

Answer 28

Difficulty Breathing Legs or Feet Swelling Fatigue

Question 29

What is Acute Heart Failure?

Answer 29

sudden onset of left ventricular failure of an acute primary event

Question 30

The most common precipitating factor of AHF is:

Answer 30

Myocardial Infarction

Question 31

What is Forward Failure? what causes it?

Answer 31

Decreased CO related to Decreased Renal Blood Flow | - It is due to altered glomerular filtration with retention of water and salt

Question 32

What is Backward Failure?

Answer 32

Increased Filling pressure of ventricles due to obstruction | -occurs with mitral or tricuspid stenosis, which causes increased venous pressure with congestion

Question 33

Left sided Heart Failure occurs:

Answer 33

By HBP or CAD

Question 34

What happens to a person with left sided heart failure of the follow? A) Preload B) Afterload C) Contractility

Answer 34

A) Increases B) Increases C) Decreases

Question 35

Catecholamine Prepares body for physical activity - increases __, __, and ___ ____ - secreted into urine after breaking down and can detect_______

Answer 35

HR, BP, Blood Glucose | Phenochromocytoma

Question 36

Renin-Angiotensin | Regulation of _____ ______ concenctration and arterial ____.

Answer 36

Plasma Sodium | BP

Question 37

Aldosterone | Stimulates ____ secretion, _____ and water reabsorption from the gut

Answer 37

Potassium | Sodium

Question 38

Antidiuretic Hormone Conserves _____. AVP is :

Answer 38

water | Arginine Vasopressin

Question 39

Endotoxin are

Answer 39

small, stable, bacterially-derived hydrophobic molecules

Question 40

Cytokines are

Answer 40

signaling molecules that mediate and regulate immunity, inflammation and hematopoiesis

Question 41

Diastolic Heart Failure | this is defined as

Answer 41

pulmonary congestion despite a normal SV and CO

Question 42

Diastolic Heart Failure Results from decreased ______ of the left ventricle and abnormal ___ ____ such that a normal ____ results in an increased _____

Answer 42

compliance; diastolic relaxation LVEDV LVEDP

Question 43

What treatments would help diastolic failure?

Answer 43

Control BP and HR Treat symptoms of HF Reduce symptoms of CAD

Question 44

Right Heart Failure Results from left ___ ____ when the increase in the left ventricle ___ ____ that is reflected back into the _____ ______ is severe enough

Answer 44

heart failure filling pressure pulmonary circulation

Question 45

Right Heart Failure | As pressure in the ____ _____ rises, the ____ to the right ventricular ____ increases

Answer 45

pulmonary circulation, resistance emptying

Question 46

Right Heart Failure | The right ventricle is _____ prepared to compensate for this increased ____ and will ____ and ____.

Answer 46

poorly workload dilate and fail

Question 47

Pulmonary Hypertension | Can be caused by a number of factors, all of which forces the heart's ___ ___ to work ____ to pump blood to the ______

Answer 47

right side harder lungs

Question 48

Pulmonary Hypertension | The right chamber may ____ as they struggle to function and ___ is often forced ____ through the ______ valve

Answer 48

enlarge blood backwards tricuspid

Question 49

Right Heart Failure | When this happens, ____ will rise in the systemic ____ _____, resulting in ____ ______ and _______

Answer 49

pressure venous circulation peripheral Edema Hepatosplenomeagaly

Question 50

High Output Failure | Is the inability of the heart to

Answer 50

adequately supply the body with blood borne nutrients, despite adequate blood volume and normal or elevated myocardial contractility

Question 51

Common causes of High-output failure are | Hint: ASHB

Answer 51

- Anemia - Septicemia - Hyperthyroidism - Beri-Beri

Question 52

Anemia:

Answer 52

- Decreases oxygen carrying capacity to the blood

Question 53

Anemia | ____ ____ occurs as the body's cells switch to _____ metabolism

Answer 53

metabolic acidosis | anaerobic

Question 54

Anemia | in response to metabolic acidosis, HR and SV _____ in attempt to circulate blood ____.

Answer 54

increases | faster

Question 55

Anemia | If anemia is ___, maximum CO does not supply the cells with enough ____ for metabolism

Answer 55

severe | oxygen

Question 56

Septicemia | during metabolism, _____ ____ and the ____ process cause systemic _____ and _____.

Answer 56

bacterial toxins; inflammatory | vasodilation; fever

Question 57

Septicemia | In overwhelming septicemia, the ___ may not be able to raise its ____ enough to compensate for ______

Answer 57

heart; output | vasodilation

Question 58

Septicemia | Body tissues show signs of inadequate ___ ___ despite a very high ___ ___

Answer 58

blood supply | cardiac output

Question 59

Hyperthyroidism This accelerates ___ ____ through the actions of elevated levels of ____ from the thyroid gland. This may occur chronically (_____) or acutely (____ _____)

Answer 59

cellular metabolism thyroxine thyrotoxicosis thyroid storm

Question 60

Beri-Beri | This condition is usually caused by malnutrition of ______ and secondary to chronic _____

Answer 60

thiamine; alcoholism

Question 61

Reversible treatment of CHF include:

Answer 61

Exercise eating healthy foods reduction in salty foods abstinence of smoking and drinking alcohol

Question 62

Drugs that can help with heart failure are:

Answer 62

- Diuretics agents - Vasodilators agents - Positive inotropes - ACE inhibitors - Beta Blockers - Aldosterone antagonist

Question 63

Cardiac Resynchronization Therapy may help patients that have:

Answer 63

- Class III or IV - LVEF of >35% - QRS interval < 120 ms

Question 64

CRT involves

Answer 64

pacing both left and right ventricles though implantation of a bi-ventricular pacemaker or surgical remodeling of the heart

Question 65

The final option, if all other measure fail is

Answer 65

cardiac transplant or implantation of an artificial heart

Question 66

A new type of surgery invented by a Brazilian doctor in 1994 involves a removal of a ____ of the left ventricle, to make ______ more efficient and prevent ____ of blood into the left atrium through the ______ valve

Answer 66

swath contractions backflow bicuspid