Heart Failure

Front 1

Does heart failure have a good prognosis

Back 1

No. It has a poor prognosis

Front 2

Half of patients diagnosed with heart failure die within

Back 2

5 years

Front 3

The common end point of many cardiac disease is

Back 3

Heart failure (CHF)

Front 4

In minor cases, heart failure can be due to

Back 4

1) Increased oxygen demand by tissues (eg hyperthyroidism)

2) Decreased oxygen carrying capacity of blood (eg anaemia)

Both cause more forceful contraction of heart muscles that can lead to concentric hypertrophy.

Front 5

Onset of Heart failure is usually ABRUPT(sudden) as seen in

Back 5

• Large myocardial infarction

• Acute valvular insufficiency

Front 6

Causes of Systolic heart failure

Back 6

a) Ischaemic Heart Disease

b) Long term Hypertension

Front 7

Causes of Diastolic heart failure

Back 7

a) Massive ventricular hypertrophy (Concentric)

b) Restrictive Cardiomyopathy that includes:

• Myocardial fibrosis

• Constrictive pericarditis

• Amyloid depositions

Front 8

Diastolic heart failure accounts for what fraction of all cases of Congestive heart failure

Back 8

Approx. 50%

Front 9

Diastolic heart failure is observed in what categories of people

Back 9

• Older adults

• Diabetic people

• Women

Front 10

Can valvular dysfunction cause heart failure?

Back 10

Yes it can. Valvular dysfunction include stenosis of the valve (that cause hypertrophy of heart chamber)

Front 11

Forward and Backward failure of the heart

Back 11

• Forward failure is the inability of heart to pump blood to receiving vessel (decreased Cardiac Output, not moving forward)

• Backward failure is the inability of heart to properly fill causing back flow of blood and venous congestion

Front 12

The CVS (basically the heart's) attempts to compensate for reduced myocardial contractility and hemodynamic burden via which mechanisms

Back 12

a) Frank-Starling mechanism (to increase contractility)

b) Activation of RAAS

c) Release of Atrial Natriuretic Peptide

d) Activation of neurohumoral systems (eg norepinephrine to increase contractility)

e) Myocardial structural changes (hypertrophy)

Front 13

If the failed heart is compensated for by Frank-Starling mechanism (i.e subjecting the functional myocardium to increased tension for greater contraction) to increase contractility, it is called

Back 13

Compensated heart failure.

Front 14

What is Decompensated heart failure

Back 14

One in which the compensated heart failure, due to increased demand for O2 causes myocardial damage from ischaemia, leading to initial low cardiac output (heart no longer pump more because the wall damaged more).

Front 15

In pressure overload states (systemic hypertension and valve stenosis), hypertrophy is caused by _ addition of sarcomere

Back 15

Parallel (Concentric hypertrophy) so as to increase wall thickness/fibre diameter to pump blood against force.

Front 16

In volume overload states (shunts and valve insufficiency/regurgitation), hypertrophy is caused by _ addition of sarcomere

Back 16

Series (eccentric hypertrophy) so as to increase chamber diameter/fibre length so it can accommodate the extra volume

Front 17

The best measurement for hypertrophy in volume overloaded hearts is

Back 17

Heart weight (since you can't measure heart muscle length). Wall thickness is not used because the wall of volume overloaded hearts may increased, remain normal or even decrease.

Front 18

In left ventricular heart failure, left ventricle is usually hypertrophied or dilated (thinned out walls) except in

Back 18

a) Mitral valve stenosis (making less blood to get into the ventricle)

b) Restrictive cardiomyopathy

Front 19

Left ventricular dilation can cause mitral valve insufficiency and left atrial enlargement. T/F

Back 19

True. This is usually associated with atrial fibrillation.

Front 20

Are Microscopic changes in Heart following Left ventricular failure, Specific or Nonspecific?

Back 20

Nonspecific

Front 21

The major microscopic feature seen in a heart with Left S.H.F

Back 21

Usually Myocytes hypertrophy with interstitial fibrosis

Front 22

Can pleural effusion also be a consequence of Left S.H.F on the lungs.

Back 22

Yes it can. (Just like ascites with right sided failure)

Front 23

The earliest and most significant clinical feature of Left S.H.F is

Back 23

Dyspnea on exertion.

Front 24

Clinical features of Left sided heart failure include

Back 24

• Dyspnea on exertion

• Orthopnea (dyspnea when recumbent, that resolves on standing or sitting)

• Paroxysmal nocturnal dyspnea

• Cough (due to fluid in sac)

• Enlarged heart/Cardiomegaly (from cause of failure)

• Tachycardia (sympathetic response to low circulatory blood volume and pressure)

• Third heart sound/S3 (from mitral regurgitation due to dilated ventricle)

• Crackles/rales at BASE OF LUNGS (on breathing)

Front 25

How does dilation of left ventricle cause mitral regurgitation

Back 25

Dilation of the left ventricle causes displacement (like further relaxation) of the papillary muscles, causing opening of the mitral valve. The regurgitation can cause a systolic murmur.

Front 26

With progression of Left sided CHF, what conditions can result

Back 26

• Prerenal azotemia (azote-nitrogen; emia-blood) due to hypoperfusion of kidney that leads to accumulation of wastes that kidney ought to eliminate

• Hypoxic encephalopathy (due to hypoperfusion of brain)

Front 27

Treatment of Left sided heart failure is focused on

Back 27

The Underlying cause.

Front 28

Treatment for Left sided heart failure include

Back 28

a) Salt restriction (to prevent high blood pressure that causes hypertrophy and failure)

b) Pharmacological agents that:

• Reduce workload on heart (diuretics to clear excess fluid)

• Increase myocardial contractility (with inotrophs)

• Reduce afterload (with ACE inhibitors, adrenergic blockers that prevent aortic constriction)

Front 29

The most common cause of right sided heart failure is

Back 29

Left sided heart failure

Front 30

Isolated right sided heart failure are very common. T/F

Back 30

False, they are uncommon. They usually occurs with left sided heart failure.

Front 31

What is cor pulmonale?

Back 31

It is right sided heart failure that occurs due to lung diseases or disorders of pulmonary blood vessels.

Front 32

Mention conditions that cause cor pulmonale

Back 32

• Primary pulmonary hypertension (R.V will have to pump with increased pressure)

• Recurrent pulmonary thromboembolism (that increase resistance causing R.V to pump harder)

• Conditions that cause pulmonary vasoconstriction eg obstructive sleep apnea (increasing pressure applied by right ventricle)

Front 33

In cor pulmonale, which structures hypertrophy

Back 33

Right ventricle and atrium majorly (but in few cases ventricular septum hypertrophies too)

Front 34

Right sided heart failure can cause effusion in

Back 34

PPP (systemic, so more than just pleural space)

P- Pleural (also seen in left sided heart failure)

P- Pericardium

P- Peritoneum (ascites)

Front 35

Does right sided heart failure cause pulmonary congestion and edema.

Back 35

No. It is strictly left that causes it.

Front 36

Pleural effusions are more pronounced when

Back 36

Their is Biventricular heart failure (because both cause pleural effusion)

Front 37

Are Effusions/edema seen in Right sided Heart failure transudate or exudate?

Back 37

They are transudate, even the ones seen in left S.H.F , because they are due to increased hydrostatic pressure and not vessel permeability.