Heart Failure

Question 1

Left sided heart failure occurs with

Answer 1

• Left ventricular insult
• Reduces CO leading to accumulation of fluid in L atrium, pulmonary congestion & pulmonary edema
• Augmented by renal mediated fluid retention

Question 2

Right sided HF occurs following

Answer 2

• Insult of right ventricle
• Commonly caused by elevated pressures in pulmonary arterial system
• Reduces R ventricular CO resulting in venous congestion leading to jugular venous distention & peripheral edema as well as ascites and pleural effusion

Question 3

Pulmonary edema produces the 2 hallmark pulmonary signs of L sided HF

Answer 3

• Dyspnea
• Cough

Question 4

Pts experiencing an acute exacerbation of HF typically present in _______________ HF where L sided HF results in pulmonary vascular congestion, R ventricular overload, & ultimately systemic vascular congestion

Answer 4

• Biventricular HF

Question 5

________________ HF may be due to either systolic or diastolic dysfunction of the L ventricle & also referred as HF with _________ or __________ ejection fraction

Answer 5

• Functional
• Reduced or Preserved

Question 6

Describe systolic dysfunction HF

Answer 6

• HF w/reduced ejection fraction
• Compromised contractile function of ventricles reducing stroke volume, CO< and ejection fraction
• L ventricular ejection fraction <40%
• Weakened heart msucle

Question 7

Describe diastolic dysfunction HF

Answer 7

• HF w/preserved ejection fraction
• Ventricles cannot fill adequately during relaxation
• L ventricular ejection fraction remains unaltered or remains b/w 55-75%
• Stiffened heart muscle

Question 8

HF with reduced ejection fraction leads to ___________ Renin Angiotensin Aldosterone System Activity

Answer 8

• Increased

Question 9

Describe cardiorenal syndrome

Answer 9

• Ischemia, cardiomyopathy, or arrhythmia leads to acute cardiac insult
• Decreased CO and perfusion
• Increased venous pressure leading to acute kidney injury

Question 10

Diagnosis of HF

Answer 10

• ECG
• Pro-BNP >125
• BNP ≥35
• Transthoracic echocardiography

Question 11

AHA stages of HF

Answer 11

• Stage A: high risk for developing HF
• Stage B: structural heart disease strongly associated w/development of HF but no s/s of HF
• Stage C: Symptomatic HF w/associated underlying structural heart disease
• Stage D: Advanced structural disease w/marked symptomology at rest despite maximal medical therapy

Question 12

NYHA classification of HF

Answer 12

• Stage I: No limitation in activity
• Stage II: Slight limitation in activity, comfortable at rest
• Stage III: Marked limitation of activity, sx w/less than ordinary activity
• Stage IV: Sx at rest, unable to do any physical activity w/o symptomology

Question 13

CPG for HF (more specific to HFrEF)

Answer 13

• Advocate for increased total daily physical activity
• Educate & facilitate chronic disease management behaviors
• Prescribe aerobic exercise training in stable HF
• Prescribe HIIT
• Prescribe resistance training
• Prescribe combined aerobic and resistance training
• Prescribe inspiratory muscle training
• Prescribe combined inspiratory muscle training & aerobic exercise training
• Prescribe neuromuscular electrical stimulation (NMES)

Question 14

Green zone for CHF (congestive heart failure) NO

Answer 14

• SOB
• Swelling
• Weight gain
• Chest pain
• Decrease in your ability to maintain your activity level

Question 15

Yellow zone for CHF (may indicate need for medication adjustment)

Answer 15

• Weight gain of ≥3 lbs in 2 days
• Increased coughing
• Increased swelling
• Increase in SOB with activity
• Increase in number of pillows needed
• Anything else unusual that bothers you

Question 16

Red zone for CHF (immediate visit to the ED)

Answer 16

• Unrelieved SOB or at rest
• Unrelieved chest pain
• Wheezing or chest tightness at rest
• Need to sit in chair to sleep
• Weight gain or loss of ≥5 lbs in 2 days
• Confusion

Question 17

Signs of exertion intolerance for CHF patients

Answer 17

• Chest pain
• Abnormal vital sign response
• New onset of pulmonary crackles
• New onset of S3 heart sound
• New onset or change in cardiac rhythm

Question 18

Treatment of heart failure could lead to _________ insufficiency requiring in to be a balancing act for treatment

Answer 18

• Renal failure/insufficiency

Question 19

ACE inhibitors end in

Answer 19

• -pril

Question 20

ARB drugs end in

Answer 20

• -sartan

Question 21

Beta blockers end in

Answer 21

• -lol