Why is heart failure considered a progressive condition?
Because almost any disease affecting the heart can lead to it, and its severity increases over time as cardiac function worsens.
Who is more likely to develop heart failure?
Those with hypertension, diabetes, metabolic syndrome, and obesity.
What is the most common cause of heart failure?
Coronary artery disease (CAD).
Why is heart failure more common today?
Increased longevity of the population and heart failure being an aging process.
What types of cardiac dysfunction can cause chronic heart failure (CHF)?
Any type of cardiac dysfunction.
CHF is most commonly attributable to dysfunction of which chamber?
The left ventricle (LV).
Isolated dysfunction of which ventricle rarely causes heart failure?
The right ventricle (RV).
What is the most common and best-studied cause of CHF?
LV systolic dysfunction.
Heart failure with normal ejection fraction is due to what?
LV diastolic dysfunction.
Define preload.
The volume of blood in the ventricles at the end of diastole (end-diastolic volume/pressure).
What conditions increase preload?
Hypervolemia, cardiac valve regurgitation, heart failure.
Define afterload.
The resistance the left ventricle must overcome to eject blood into circulation.
What conditions increase afterload?
Hypertension and vasoconstriction.
What is the effect of increased afterload on cardiac workload?
Increased Afterload = Increased Cardiac workload.
What does the Frank-Starling curve illustrate?
The relationship between venous return (EDV/EDP/atrial pressure) and stroke volume/cardiac work.
Describe the blood flow pathway through the heart and lungs in simple steps.
Right heart → pulmonary artery → lungs → pulmonary veins → left heart → aorta → systemic arteries → tissues → systemic veins → right heart.
What differentiates right-sided heart failure from left-sided heart failure?
Right HF: systemic venous congestion
Left HF: pulmonary congestion + reduced cardiac output
What are the major consequences of right-sided heart failure?
Peripheral tissue congestion
Oedema + ascites
Liver congestion → impaired liver function
GI tract congestion → anorexia, GI distress, weight loss
What are the major consequences of left-sided heart failure?
Pulmonary congestion
Decreased cardiac output → activity intolerance
Signs of decreased tissue perfusion
Cyanosis and hypoxia
Orthopnea
Paroxysmal nocturnal dyspnea (PND)
Cough with frothy sputum
What is the vicious cycle of heart failure?
- Myocardial injury
- Decreased Ventricular performance
- Decreased Cardiac output
- Activation of neurohormonal system (SNS + RAAS)
- Vasoconstriction + Na/H₂O retention
- Increased demand on heart
- Worsening myocardial injury
What neurohormonal systems worsen heart failure?
Sympathetic nervous system
RAAS system
Vasopressin release
Endothelin and inflammatory cytokines
How does angiotensin II worsen heart failure?
Causes vasoconstriction (increases after-load)
Stimulates aldosterone → Na/H₂O retention (increases preload)
Promotes ventricular remodelling
What is ventricular remodeling in HF?
Structural changes in myocardium → hypertrophy, dilation, impaired contractility.
What happens to systolic, diastolic, and mean arterial pressure as blood moves from the aorta → veins?
All decrease, and pulsatility disappears in the arterioles/capillaries.
