Heart Failure Exam Questions With Complete Solutions

Heart Failure Exam Questions With Complete Solutions Most heart failure begins with failure of the ___ ventricle and progresses to: - ANSWER- -Left ventricle -Failure of both ventricles Overall, heart failure is most often caused by (in order): - ANSWER- 1. Systemic hypertension 2. Structural heart changes 3. MI What are the types of heart failure - ANSWER- -Left sided heart failure -Right sided heart failure Heart Sounds - ANSWER- *S1* -Heard as the atrioventricular valves close -Heard loudest at the apex *S2* -Heard when the semilunar valves close -Heard lodes at the base of the heart *S3* -Heard if ventricular wall compliance is decreased and structures in the ventricular wall vibrate -May occur in conditions like heart failure or alular regurgitation -Often the first sign of heart failure *S4* -Heard on atrial systole if resistance to ventricular filling is present -Causes include cardiac hypertrophy, disease, or injury to the wall -Not a sign of heart failure, it is a reflection of decreased ventricular compliance The most common type of heart failure is ____ sided heart failure - ANSWER- Left Left sided heart failure is aka - ANSWER- Congestive heart failure Indications of left sided heart failure: - ANSWER- -*Decreased tissue perfusion* due to poor cardiac output -*Pulmonary congestion* from increased pressure in the pulmonary vessels Typical causes of left sided heart failure are - ANSWER- -Hypertension -Coronary artery disease -Alular disease involving the mitral or aortic valve What are the subdivisions of left sided heart failure? - ANSWER- -Systolic left sided heart failure -Diastolic left sided heart failure Systolic left sided heart failure is a condition in which: - ANSWER- The heart cannot contract forcefully enough during systole to eject adequate amounts of blood into circulation What happens in systolic left sided heart failure - ANSWER- -*There will be in increase in preload and after load* →Preload is increased b/c of decreased constriction →Afterload is increased because of increased peripheral resistance -*The ejection fraction drops from normal (50-70%) to < 40%* →As this decreases, tissue perfusion is decreased and blood accumulates in the pulmonary vessels Afterload is: - ANSWER- The amount of resistance the heart faces to pump the blood -As afterload increases, the amount of energy the left ventricle needs to pump the blood is increase Ejection fraction is: - ANSWER- The percent of blood ejected from the heart during systoles Diastolic left sided heart failure is a condition in which: - ANSWER- The left ventricle cannot adequately relax during diastole. This "stiffens" the heart and prevents the ventricle from filling with enough blood for heart to pump out. -The ejection fraction will be >40%, however, the ventricle becomes less compliant over time because more pressure is needed to move the same amount of volume Diastolic left sided heart failure vs. systolic left sided heart failure - ANSWER- -With diastolic, ejection fraction is >40%, vs. < 40% with systolic Causes of right sided heart failure: - ANSWER- -Prolonged, untreated left ventricular failure -Right ventricular myocardial infarction -Pulmonary hypertension Overall, right sided heart failure is usually the result of - ANSWER- Pulmonary problems like COPD Right sided heart failure is a condition in which: - ANSWER- The right ventricle cannot completely empty, causing fluid to to be retained and venous pressure to increase Indications of right sided heart failure: - ANSWER- -Peripheral edema -Jugular vein distension Cardiac Output= ___ x ____ - ANSWER- Heart Rate Stroke Volume What are the compensatory mechanisms of insufficient cardiac output? - ANSWER- - Stimulation of the Sympathetic nervous system -Renin-Angiotensin System activation -Chemical responses (BNP) -Myocardial hypertrophy What happens when the body stimulates the sympathetic nervous system in response to decreased cardiac output - ANSWER- -When the body senses decreased pressure, it stimulates the sympathetic nerve fibers to release norepinephrine in order to: →Increase heart rate →Increase atrial and ventricular contractility →Increase blood pressure by increasing peripheral vasoconstriction Drawbacks to the stimulation of the sympathetic nervous system - ANSWER- -This significantly increases the rate at which the heart consumes oxygen. If the heart has poor perfusion due to arteriosclerosis, HF may worsen -It stimulates increased venous return, thus it stretches the vessel walls. There is a point in which the muscle fibers stretch so much because of increased volume that force of contraction and cardiac output is decreased -Excessive heart rate can reduce ventricular fillin