Heart Failure

Question 1

T/F: the heart stores up lots of energy

Answer 1

FALSE
the heart matches its energy needs for its contractile activity with energy synthesis in real time

Question 2

describe the importance of the O2 supply chain to cardiac activity

Answer 2

the heart generates almost all of its energy needed through aerobic metabolism

if O2 cannot be delivered to cardiac tissue, we will not have enough available for synthesis of energy and thus dysfunction occurs

Question 3

what are the cardinal s/s of cardiac dysfunction?

Answer 3

1. inappropriate fatigue and/or weakness
2. dyspnea (SOB)
3. exercise intolerance
4. rapid or irregular heartbeat
5. bilateral LE swelling
6. persistent cough

Question 4

explain how EF can remain unchanged despite changes in LVEDV or LVESV

Answer 4

relate it to the gas gauge in a smart car vs a truck.

their gas gauges may look the same but it doesn’t tell you the actual volume of gas in each car

Question 5

what factors determine SV? HR? CO?

Answer 5

CO = SV * HR

HR → parasympathetic and sympathtic tone influence HR

SV → preload, contractility, and afterload all influence SV

Question 6

what regulates coronary arteries?

Answer 6

1. coronary artery pressure
2. local metabolic signals
3. signals from the endothelium
4. neutral and hormonal molecules

Question 7

define heart failure

Answer 7

a complex clinical syndrome that results from any structural or functional impairment of ventricular filling (preload) or ejection of blood (afterload)

The situation where the heart is incapable of maintaining a CO adequate to accomodate metabolic needs and venous returns

Question 8

list some causes of heart failure

Answer 8

1. CAD/ischemic heart disease (IHD)
2. uncontrolled HTN (pulmonary or systemic)
3. Valvular disease
4. uncontrolled diabetes
5. long standing ETOH abuse
6. Hx of MIs
7. Age
8. Age associated increased ventricular stiffness

Question 9

what are the s/s of HF?

Answer 9

1. exertional dyspnea
2. orthopnea (SOB in supine)
3. Paroxysmal nocturnal dyspnea (SOB at night)
4. fatigue

Question 10

List common clinical signs of HF

Answer 10

1. fluid retention
2. ascites
3. pleural effusions
4. jugular venous distension (JVD)
5. heptomegaly (enlargement of liver)
6. pitting edema
7. tachycardia
8. S3 gallop (specific EKG change)

Question 11

how is HF classified?

Answer 11

Right vs Left sided heart failure

congestive heart failure

HFpEF vs HFrEF

Functional

Question 12

describe left sided HF

Answer 12

contractility of LV is reduced → LV does not pump as efficiently as a healthy heart

this results in:

• reduced SV, EF, and CO
• collectively blood flow to the body is reduced
• fatigue, exercise intolerance, SOB

Question 13

what are some causes of left sided HF?

Answer 13

1. HTN → cardiac hypertophy leads to cardiac remodeling and reduced contractility
2. CAD → chronic ischemic damage to the myocardium leads to remodeling and scaring in myocardium which reduces contractility
3. Arrhythmias
4. decreased CO caused by impaired ventricular filling and decreased ventricular relaxation

Question 14

describe the progression of left sided HF

Answer 14

1. reduced LV contractility
2. reduced LV SV and EF
3. causes vascular congestion:
   
   • increase in LVEDV and thus increase in LVEDP (pressure increase)
   • specifically pulmonary congestion
4. decrease in blood movement from LA to LV during ventricular diastole
5. increase in blood accumulation in LA causing an increase in LA diastolic pressure
6. decreased blood mvoement from lungs into LA
7. increase in blood volume in pulmonary circulation (congestion)
8. pulmonary edema
   
   • hemoptysis → blood suptum

Question 15

list s/s of left sided HF

Answer 15

1. SOB, dyspnea
2. fatigue, tiredness, exertional dyspnea
3. waking up feeling like you are suffocating
   
   • orthopnea
   • paroxysmal nocturnal dyspnea
4. decreased urine production
5. cough that develops with reclining
6. mitral valve regurgitation

Question 16

describe right sided HF

Answer 16

contractility of RV is reduced → RV does not pump as efficiently as a healthy heart

impact:

• accumulation (congestion) of blood in RV, RA, and in systemic circulation resulting in systemic s/s

Question 17

list s/s of right sided HF

Answer 17

1. abdominal blotting/swelling/ascites
2. kidney failure
3. JVD
4. weight gain
5. dependent edema
6. increased frequency of deep vein thrombi and PE’s

Question 18

what is congestive heart failure (CHF)?

Answer 18

a clinical condition in which the heart is unable to pump enough blood to meet the metabolic needs of the body because of pathological changes in the myocardium

often used synonymously with left HF and right HF

Question 19

T/F: CHF is the most common type of HF seen in clinic

Answer 19

TRUE

Question 20

describe the clinical progression/changes that occurs with CHF

Answer 20

1. Normal
   
   • no symptoms, normal exercise, normal LV fxn
2. Asymptomatic LV dysfunction
   
   • no symptoms, normal exercise, abnormal LV fxn
3. Compensated CHF
   
   • no symptoms, decreased exercise, abnormal LV fxn
4. Decompensated CHF
   
   • symptoms, decline in exericse, abnormal LV fxn
5. Refractory CHF
   
   • symptoms not controlled with trx

Question 21

how can HF be staged?

Answer 21

Stages A → D

Question 22

describe stage A HF

Answer 22

people at high risk for developing HF in the future but no functional or structural heart disorder.

pre-heart failure

Question 23

describe Stage B HF

Answer 23

a structural heart disorder but no symptoms at any stage

Question 24

describe Stage C HF

Answer 24

previous or current symptoms of HF in the context of an underlying structural heart problem, but managed with medical trx

Question 25

describe Stage D HF

Answer 25

advanced disease requiring hospital based support, a heart transplant or palliative care

Question 26

describe acute HF

Answer 26

HF symtpoms appear suddenly or a rapid worsening of existing symptoms of HF occurs sudden onset of dyspnea and limb and LE swelling 5 lb rule

Question 27

what is the 5lb rule?

Answer 27

if you see an increase in 5lbs within 25 hrs call your physcian

Question 28

describe systolic HF (also called HFrEF)

Answer 28

LV contractility is reduced in turn reducing EF and O2 delivery to the periphery also called HF with reduced ejection fraction (HFrEF) net effect reduced delivery of blood into systemic circulation and subsequent O2 delivery

Question 29

describe diastolic HF (HFpEF)

Answer 29

reduced ability for filling of chambers nearly half of all pts with HF have a normal EF seen more frequently in: * females * older age * HTN * metabolic syndrome, renal dysfunction * Obesity

Question 30

describe the pathophysiology of diastolic HF

Answer 30

1. the ventricles lose their ability to relax normally 2. ventricles become stiffer and less compliant 3. heart chambers cannot fill normally during diastole 4. global loss of cardiac, vascular and peripheral reserve 5. often have pulmonary HTN and exercise intoleranc

Question 31

which type of HF impacts men more than women?

Answer 31

Systolic HF (HFrEF)

Question 32

which type of HF impacts women more than men?

Answer 32

diastolic HF (HFpEF)

Question 33

which type of HF results in more hospitalizations?

Answer 33

Systolic HF (HFrEF)

Question 34

T/F: HF is recognized as a neuroendocrine disease

Answer 34

TRUE

Question 35

what types of medications might your pt be on if they have HF?

Answer 35

1. Diuretics 2. Beta blockers 3. ACE inhibitors/ARBs 4. Calcium channel blockers 5. Vasodilators 6. Positive iontropes

Question 36

HF is not an exclusive cardio-centric disease, what other organs/tissues can it impact?

Answer 36

1. endothelial dysfunction 2. skeletal muscle damage 3. decreased systemic blood flow and accompanying increased total peripheral resistance secondary to excessive sympathetic stimulation causing vasoconstriction 4. kidney dysfunction

Question 37

T/F: we should not exercise a pt with HF

Answer 37

FALSE exercise training is a key intervention for pts with HF