Lecture 4: Heart Failure

Question 1

What does increasing preload cause?

Answer 1

Increased tension on ventricular walls, ultimately increasing oxygen demand

Question 2

What is afterload?

Answer 2

Amount of pressure from peripheries acting on heart

Question 3

What does a high afterload mean?

Answer 3

Hard for blood to leave heart

Question 4

What 3 factors increase stroke volume?

Answer 4

• Increased contractility
• Increased preload
• Decreased afterload

Question 5

What is stroke volume?

Answer 5

Volume of blood ejected with each beat of the heart

Question 6

What does increasing stroke volume do to cardiac output?

Answer 6

Increases it

Question 7

What is vascular/peripheral resistance?

Answer 7

“Squeeze” of blood vessels outside the heart resisting blood flow

Question 8

Describe the Frank-Starling Law

Answer 8

Preload and afterload will decrease in relation to stroke volume for a patient with heart failure

Question 9

Why might the heart need to produce compensatory mechanisms? (Think of the highway analogy)

Answer 9

• MI (one lane closed)

- Increased BP (traffic jam)

Question 10

What are the 4 compensatory mechanisms?

Answer 10

1) Increased heart rate
2) Increased preload from activation of RAAS
3) Vasoconstriction
4) Ventricular hypertrophy

Question 11

What are the pros of the compensatory mechanism of increasing heart rate?

Answer 11

Maintains CO

Question 12

What are the pros of the compensatory mechanism of increasing preload using RAAS?

Answer 12

Increased stroke volume

Question 13

What are the pros of the compensatory mechanism of peripheral vasoconstriction?

Answer 13

Maintains BP

Question 14

What are the pros of the compensatory mechanism of ventricular hypertrophy?

Answer 14

• Maintains CO

- Decreases oxygen demand

Question 15

What are the cons of the compensatory mechanism of increasing heart rate?

Answer 15

• Short filling time

- Increased oxygen demand

Question 16

What are the cons of the compensatory mechanism of increasing preload using RAAS?

Answer 16

• Edema

- Increased oxygen demand

Question 17

What are the cons of the compensatory mechanism of peripheral vasoconstriction?

Answer 17

Increased afterload causing decreased stroke volume

Question 18

What are the cons of the compensatory mechanism of ventricular hypertrophy?

Answer 18

Increased risk of ischemia and arrhythmias

Question 19

What do natriuretic peptides do?

Answer 19

• Secreted by brain and aorta to counteract negative compensatory mechanisms in heart failure
• Promote water loss, causing a decreased TPR
• Inhibits aspects of RAAS
• Vasodilation

Question 20

What is left-sided heart failure?

Answer 20

Blood is backed up in lungs

Question 21

What is right-sided heart failure?

Answer 21

Blood is backed up in abdominal organs and periphery

Question 22

What are 6 signs and symptoms of heart failure?

Answer 22

1) Fluid retention and edema
2) Shortness of breath
3) Fatigue
4) Cyanosis
5) Hypertrophy
6) Confusion

Question 23

What can fluid retention cause?

Answer 23

• Excessive weight gain in a short period of time
• Pitting edema (squishy feet/ankles)
• Rales

Question 24

What is rales?

Answer 24

Crackling sounds on auscultation with stethoscope

Question 25

What can shortness of breath cause?

Answer 25

- Increased JVP - Dyspnea - Orthopnea - Cough

Question 26

What is dyspnea?

Answer 26

Difficulty breathing

Question 27

What is orthopnea?

Answer 27

Difficulty breathing laying down

Question 28

What is cyanosis?

Answer 28

Oxygen depletion

Question 29

What can fatigue, cyanosis, and fatigue cause?

Answer 29

Decreased cardiac output

Question 30

What is a sign of cyanosis?

Answer 30

Blue lips, fingers, or toes

Question 31

What are 6 diagnostic tests used to diagnosis heart failure?

Answer 31

1) Chest X-Ray 2) Echocardiogram 3) JVP 4) Pulmonary edema 5) Peripheral edema 6) Ascites

Question 32

Why is a chest x-Ray used to diagnosis heart failure?

Answer 32

Look for an enlarged cardiac silhouette (over 50% increase)

Question 33

Why is an echocardiogram useful in diagnosing heart failure?

Answer 33

- Use ultrasound to detect abnormalities in structure and function - Look at LVEF (left ventricular ejection fraction)

Question 34

What is a normal LVEF?

Answer 34

55-70%

Question 35

What is an LVEF normal of someone with heart failure?

Answer 35

Less than 40%

Question 36

What is JVP and why is it used for heart failure diagnostics?

Answer 36

- Jugular venous pressure | - Elevation indicates a volume overload

Question 37

What is ascites?

Answer 37

Fluid accumulation in peritoneal space

Question 38

What are 5 non-pharmacological treatments for heart failure?

Answer 38

1) Salt restriction 2) Fluid restriction 3) Stop smoking 4) Monitor weight daily 5) Exercise once symptoms are controlled

Question 39

What is preload?

Answer 39

Stretch of ventricles when filled