24 Questions
What is the primary characteristic of systolic heart failure?
Reduced stroke volume due to reduced contractility
What is a common underlying condition that leads to right-sided heart failure?
Pulmonary valve/tricuspid valve regurgitation
What is a key feature of high output heart failure?
High cardiac output >8L/min
What is the primary difference between systolic and diastolic heart failure?
Systolic HF has reduced ejection fraction, while diastolic HF has preserved ejection fraction
What is a common consequence of ventricular remodeling in heart failure?
Progressive ventricular dilatation or eccentric hypertrophy
What is the normal range of ejection fraction?
55-70%
What is a characteristic of diastolic heart failure?
Preserved ejection fraction with increased stiffness of ventricular walls
What is the primary mechanism underlying right-sided heart failure?
Reduced contractility
In a failing myocardium, which of the following statements is true regarding the Frank-Starling mechanism?
Beyond the physical limit, further increases in preload have a negative effect on stroke volume.
Which of the following types of heart failure is characterized by a rapid onset of symptoms and/or signs of heart failure?
Acute heart failure
What is the term for the complex clinical syndrome resulting from any structural and/or functional impairment of ventricular filling or ejection?
Heart failure
Which of the following is NOT a common cause of acute heart failure?
Chronic cardiomyopathy
What is the term for the process by which the ventricles are reshaped in response to injury or disease?
Ventricular remodelling
Which type of heart failure is characterized by impaired ventricular relaxation and filling?
Diastolic heart failure
What is the primary mechanism by which the renin-angiotensin-aldosterone system contributes to worsening heart failure?
Increased sodium retention leading to increased water retention and circulating volume
Which of the following is a common cause of right-sided heart failure?
Respiratory disease
What is the term for the combination of signs and symptoms of both left-sided and right-sided heart failure?
Congestive heart failure
Which of the following is NOT a sign of left-sided heart failure?
Jugular venous distension
What is the term for the increase in heart size and thickness in response to chronic overload?
Ventricular remodelling
Which of the following is a cause of high-output heart failure?
AV fistula
What is the term for the decreased ability of the heart to relax and fill with blood during diastole?
Diastolic heart failure
Which of the following is a sign of right-sided heart failure?
Jugular venous distension
What is the term for the inability of the heart to pump enough blood to meet the body's needs?
Systolic heart failure
Which of the following is a symptom of left-sided heart failure?
Dyspnoea
Study Notes
Heart Failure
- Characterised by progressive symptoms with episodes of acute deterioration
- Classified into systolic (HFrEF) or diastolic (HFpEF) heart failure
Ejection Fraction
- Stroke volume: 70ml
- End-diastolic volume (EDV): 110ml
- Ejection fraction: 64% (normal: 55-70%)
Systolic Heart Failure (HFrEF)
- Heart cannot pump enough blood
- Systolic dysfunction
- Reduced stroke volume due to reduced contractility
- Examples: MI, dilated cardiomyopathy
- Reduced ejection fraction
- Progressive ventricular dilatation or eccentric hypertrophy
Diastolic Heart Failure (HFpEF)
- Reduced filling of the heart
- Diastolic dysfunction
- Preserved ejection fraction
- Associated with concentric hypertrophy
- Increased stiffness of ventricular walls
- Increased afterload
- Reduced preload: MI, constrictive pericarditis, cardiac tamponade
Ventricular Remodelling
- Occurs in both systolic and diastolic heart failure
Right-Sided Heart Failure
- Reduced contractility: MI
- Increased afterload
- Increased preload: pulmonary valve/tricuspid valve regurgitation
- Often develops from left-sided heart failure
High Output vs Low Output Heart Failure
- High output HF: high CO >8L/min, but heart unable to meet increased demand despite normal cardiac function
- Frank-Starling mechanism: increased venous return increases stroke volume via increased contractile strength of the left ventricle
- Failing myocardium: beyond a limit, further increases in preload have a negative effect on stroke volume
Acute vs Chronic Heart Failure
- Acute heart failure: rapid onset of symptoms, requires urgent evaluation and treatment
- Chronic heart failure: progressive cardiac dysfunction from structural and/or functional cardiac abnormalities
Pathophysiology of Heart Failure
- Decreased CO causes decreased BP
- Reduced BP stimulates sympathetic drive, leading to increased heart rate and peripheral resistance
- Activation of the renin-angiotensin-aldosterone system, causing sodium retention, water retention, and vasoconstriction
Signs and Symptoms - Left-Sided Heart Failure
- Pulmonary congestion and oedema
- Decreased ventilation and hypoxia
- Reduced CO and BP, compensated by increased TPR
- Organ malperfusion can affect brain, heart, kidney, and intestine
- Symptoms: dyspnoea, cough, orthopnoea, paroxysmal nocturnal dyspnoea
- Signs: crackles/rales on auscultation, tachycardia, cardiomegaly, 3rd and 4th heart sounds
Signs and Symptoms - Right-Sided Heart Failure
- Increased pressure in pulmonary veins, making it difficult for RV to pump through pulmonary circulation
- Causes difficulty breathing, swelling, and chest discomfort
- Symptoms: dyspnoea, chest discomfort, swelling
- Signs: jugular venous distension, hepatic congestion, peripheral oedema, ascites
This quiz covers the characteristics and types of heart failure, including atrial fibrillation and ejection fraction. Learn about systolic and diastolic heart failure and how ejection fraction is calculated.
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