Heart Failure

Question 1

Define heart failure

Answer 1

Failure of heart to supply oxygen to periphery

Question 2

What are the underlying problems of heart failure?

Answer 2

Left ventricular dysfunction

Neuroendocrine activation

Question 3

True/False? The pathology of Congestive heart failure is complex

Answer 3

True

Question 4

What are the Four classes of congestive heart failure?

Answer 4

Class I:
Failure associated with no limitations on ordinary activities and activities, but revealed during exercise

Class II:
Slight limitation on ordinary activity resulting in fatigue/palpitations

Class III:
No symptoms at rest but fatigue etc with less than ordinary physical activity

Class IV:
Associated with symptoms even at rest

Question 5

What are the three immediate effects of congestive heart failure?

Answer 5

Reduced cardiac output
Excessive sympathetic discharge
Salt/water retention

Question 6

What are the three long term effects of congestive heart failure?

Answer 6

Remodeling (of vascularization)
Cardiac Hypertrophy
Cardiac apoptosis

Question 7

What is preload / afterload?

Answer 7

Preload: Atrial pressure (diastolic pressure)
Afterload: Vascular resistance (systolic pressure)

Question 8

What are the four factors that affect cardiac output and how are they altered?

Answer 8

Preload: increased by increased blood volume/venous tone

Afterload: increased due to reflex sympathetic outflow/RAAS

Contractility: reduction in pump performance

Heart Rate: Increases through sympathetic NS compensation

Question 9

Normally an increase in preload would show a(n) _______ in ventricular performance, but in the case of congestive heart failure the slope is _______

Answer 9

increase

decreased (still positive)

Question 10

What is a compensatory response to congestive heart failure?

Answer 10

Kidney thinks body is hypotensive and RAAS kicks in

Question 11

Name a positive inotropic drug class and a drug in that class, it’s mechanism, and possible side effects

Answer 11

Cardiac glycosides (Digoxin)

Block Na/K ATPase
Cardiac parasympathetic effect
-Slows heart rate AND increases contractile force

• v. toxic
• causes arrhythmias
• upsets GI
• Neuroendocrine effects (rare)

Question 12

True/False? Positive inotropic drugs are the first line again congestive heart failure

Answer 12

False, used as last resort

Question 13

Name a diuretic, describe its mechanism and potential side effect

Answer 13

Furosemide

Lowers blood volume

• hypokalemia

Question 14

Name two types of angiotensin antagonists, and an example of each. Describe their mechanisms and potential side effects

Answer 14

ACE inhibitors (Captopril):
Reduces Angiotensin II synthesis
-Renal damage

Receptor agonists (Losartan):
Block AT1-type Receptors
- Contraindicated in pregnancy

Question 15

Name a beta blocker that helps with heart failure

Answer 15

Metoprolol (mechanism unknown)

Question 16

Name a beta-agonist that helps with heart failure

Answer 16

Dobutamide

Question 17

Name a phosphodiesterase inhibitor that helps with heart failure

Answer 17

Theophylline

Question 18

Name a vasodilator that helps with heart failure

Answer 18

Nitroglycerin

Question 19

True/False? Heart Failure can lead to fluid accumulation in ankles and lungs

Answer 19

True