Cardiovascular System: Heart Failure and Regulation

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Questions and Answers

What is the formula for cardiac output?

CO = HR / SV

CO = HR - SV

CO = HR × SV (correct)

CO = HR + SV

What is the primary symptom of heart failure with reduced ejection fraction?

Dyspnea on exertion (correct)

Orthopnea

Tachypnea

Cough

What is the usual ejection fraction in heart failure with reduced ejection fraction?

40%

50% (correct)

60%

30%

Which of the following is a cause of systolic dysfunction?

All of the above Signup and view all the answers

What is the best management for a patient with heart failure and orthopnea?

Add Hydrochlorothiazide Signup and view all the answers

What is the NYHA classification of the patient in Case #1?

NYHA III Signup and view all the answers

What is the goal of pharmacologic management in heart failure with reduced ejection fraction?

To control blood pressure and volume overload Signup and view all the answers

What happens in left-sided heart failure?

Blood cannot be adequately pumped from LV to periphery, accumulating in the LV and backing up into lungs Signup and view all the answers

What is a characteristic of right-sided heart failure?

Systemic edema Signup and view all the answers

What is a common non-specific symptom of heart failure with reduced ejection fraction?

Fatigue Signup and view all the answers

Which of the following is a recommended pharmacologic treatment for heart failure with reduced ejection fraction?

Anticoagulation for patients with HF who have permanent, persistent, or paroxysmal AF with an additional risk factor for stroke Signup and view all the answers

What is the preferred term for the condition where the heart is unable to fill or eject blood?

Heart Failure Signup and view all the answers

What is the recommendation for nondihydropyridine calcium channel blockers in patients with a low EF?

Should be avoided due to negative inotropic effects Signup and view all the answers

What is the preferred antiarrhythmic in patients with HFrEF?

Dofetilide Signup and view all the answers

What is the normal range of Left Ventricular Ejection Fraction (LVEF)?

55% or higher Signup and view all the answers

What is the classification of Heart Failure with an Ejection Fraction of 35%?

Heart Failure with Reduced Ejection Fraction (HFrEF) Signup and view all the answers

What is the role of device therapy in heart failure?

The information about device therapy is not provided Signup and view all the answers

Why can amlodipine be considered for use in heart failure patients?

It has neutral effects on morbidity and mortality in HF Signup and view all the answers

What is the leading cause of Heart Failure with Reduced Ejection Fraction (HFrEF)?

Coronary Artery Disease Signup and view all the answers

What percentage of Heart Failure cases are attributed to nonischemic cardiomyopathy?

One third Signup and view all the answers

What is the recommendation for anticoagulation in patients with HF who have permanent, persistent, or paroxysmal AF without an additional risk factor for stroke?

It is reasonable for these patients Signup and view all the answers

What is the term for Heart Failure caused by conditions that place a great demand on the heart?

Heart Failure due to Increased Demand Signup and view all the answers

What is the common characteristic of conditions that lead to Heart Failure with Reduced Ejection Fraction (HFrEF)?

They all place a great demand on the heart Signup and view all the answers

What is the term for the type of Heart Failure that is previously known as Systolic Heart Failure?

Heart Failure with Reduced Ejection Fraction (HFrEF) Signup and view all the answers

Study Notes

Heart Failure

Heart failure is a complex, progressive clinical syndrome caused by any structural or functional cardiac disorder that impairs the ability of the ventricle to fill or eject blood.

Regulation of Cardiac Output

Cardiac output (CO) is regulated via ejection impedance, wall tension, and regional wall geometry.
Contractility is influenced by adrenergic activity and circulating catecholamines.

Types of Heart Failure

Left-sided heart failure: blood cannot be adequately pumped from the left ventricle (LV) to the periphery, accumulating in the LV, leading to pulmonary edema.
Right-sided heart failure: blood cannot be pumped from the right ventricle (RV) to the lungs, accumulating in the RV, leading to systemic edema.

HFrEF (Heart Failure with Reduced Ejection Fraction)

Definition: heart failure with an ejection fraction (EF) ≤ 40%.
Pathophysiology: decreased contractility, influenced by adrenergic activity and circulating catecholamines.
Causes: coronary artery disease, hypertension, nonischemic cardiomyopathy, myocarditis, idiopathic, tachycardia, and peripartum.

HFrEF Algorithm

Algorithm for pharmacologic management of heart failure with reduced ejection fraction.
Guideline-directed treatment algorithm for patients with ACC/AHA stage C heart failure with reduced ejection fraction.

Pharmacologic Management

Anticoagulation: recommended for HF with permanent, persistent, or paroxysmal AF with an additional risk factor for stroke.
Statins: not recommended solely on the basis of HF diagnosis.
Antiarrhythmics: dofetilide and amiodarone are preferred for patients with HFrEF.
Nondihydropyridine calcium channel blockers (CCBs) with negative inotropic effects can be harmful in patients with a low EF and should be avoided.

Clinical Presentation

Primary symptoms: dyspnea (especially on exertion), fatigue, and exercise intolerance.
Other symptoms: orthopnea, paroxysmal nocturnal dyspnea, tachypnea, cough, fluid overload, and peripheral edema.
Nonspecific symptoms: fatigue, nocturia, hemoptysis, abdominal pain, anorexia, nausea, bloating, ascites, poor appetite, and weight gain or loss.

Diagnosis

Assessment of fluid status.
Assessment of ejection fraction (usually < 50%).

Case Study

Ms. L, a 75-year-old with heart failure (NYHA III) and atrial fibrillation, is on Captopril, Bisoprolol, and Furosemide.
The best management for this patient is to increase the dose of Bisoprolol to 25 mg bid.

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Description

This quiz covers the complex clinical syndrome of heart failure, its causes, and the regulation of cardiac output. It also explores the different types of heart failure.