Lecture 02 Heart Failure and Valvular Dysfunction

The Frank-Starling mechanism suggests that, within physiological limits, the more distension the heart experiences at end diastole, the ________ volume it is able to pump out.

Which factors will affect the Frank-starling mechanism?

In a failing heart, the SV - end diastolic volume curve will be (higher/lower) than the normal heart.

T/F: A failing heart does NOT adhere to the frank-starling law.

Which conditions can increase preload of the heart?

Which conditions can increase afterload?

Normal SV is about ________.
If it falls below ______, it is problematic.

Normal EF is about ___%. If it is below ____, it is problematic.

Normal CO range:

Normal HR:

Systolic heart failure refers to when the EF is below _______%. It is also called a _______.

A diastolic heart failure is one that has a EF of about ___% or more. It is also called a __________. It is problematic because the total amount of blood ejected each time is _________.

List some major problems that could lead to heart failure.

Outline the big picture of HTN leading to HF.

In endurance-trained athletes, the overload is (pressure/volume). This results in (concentric/eccentric) hypertrophy, which makes the cardiac wall ____, chambers ____, and the sarcomeres are organized in _______.

Causes of pathophysiological eccentric hypertrophy include _____ and ______.

In strength-trained athletes, the overload is (pressure/volume). This results in (concentric/eccentric) hypertrophy, which makes the cardiac wall ____, chambers ____, and the sarcomeres are organized in _______.

Causes of pathophysiological concentric hypertrophy are

Aside from concentric hypertrophy, there are many other potential causes for HFpEF. List 5 of them.

Aside from eccentric hypertrophy, what other factors may cause HFrEF?

Which factors from above may cause either HFpEF or HFrEF?

What are the downstream effects of SNS in the long term?

What happens downstream after RAAS activation?

The SNS can be inhibited by _________ while the RAAS pathway can be inhibited by ____________.

What are some biomarkers that are released in proportion to severity of HF?

Explain the RAAS pathway

T/F: A patient without previous symptoms may experience a sudden, acute failure.

T/F: The first episode is less likely to cause death as compared to additional episodes.

What is the most prominent manifestation of LV failure?

As HF advances, the patient may experience ______, and _______.

Patient with LV failure may experience nocturnal cough and _________.

Why might the patient have dulled mental status and decreased urine output?

As compared to LV failure, RV failure is usually accompanied by _______ and _______.

Why may a patient with RV failure have enorexia?

T/F: A patient with LV HF is more likely to have overnight weight gain.

What are some other clinical findings that support heart failure?

Match the symptoms with left-sided failure or right-sided failure.
1. Orthopnea
2. JVD
3. Fatigue
4. Restlessness
5. Tachycardia
6. Ascites
7. Paroxysmal nocturnal dyspnea
8. Elevated pulmonary capillary wedge pressure
9. Anorexia and GI distress
10. Weight gain
11. Cyanosis
12. Pulmonary congestion
13. increased peripheral venous pressure
14. dependent edema
15. exertional dyspnea

What are some diagnostic tests for HF?

Treating congestive heart failure involves 'UNLOAD FAST', what are these treatments?

Outline the medical management for chronic heart failure.

The 5-year mortality rate following dx of HF is _______.

What are the patient presentations of Stage A HF?

What are the patient presentations of Stage B HF?

What are the patient presentations of Stage C HF?

What are the patient presentations of Stage D HF?

Class I

Class II

Class III

Class IV

Make a table to differentiate CAD and HF.

What is stenosis?

What are some causes for aortic stenosis?

Aortic stenosis causes ____ outflow obstruction, which increases ____ pressure, leading to ______ LV mass, and hence LV dysfunction.

LVET stands for ______. Increased LVET will increase the _______ of the heart, and reduce ___________. This together with increased LV mass result in ischemia of myocardial tissue, leading to heart failure.

Why is decreased diastolic time result in decreased myocardial oxygen supply?

Which pressure is reduced by LV outflow obstruciton?

What type of hypertrophy in the LV is caused by aortic valve stenosis?

________ is the most common valvular defect.

Mild, asymptomatic AS has (slow/fast) progression. About ____% of AS patients will end up having severe or symptomatic AS.

Clinical signs of AS. (SAD)

Why might the patient experience exertional syncope when having AS?

Why might the patient with AS have angina?

T/F: Patient usually don't experience palpitations during AS.

What might you here in heart sounds of a patient with AS?

S4 is associated with atrial contraction into a _______ left ventricle.

Upon palpation, an AS patient's carotid pulse may be ___________.

What is the gold-standard of AS diagnosis?

What may happen to the patient's ECG if he/she has severe AS?

What are some possible treatments for AS?

While tissue valve used for TAVR can last for ___ years, mechanical valves can last for _________. However, there is no medication required for _______ valve (other than ASA), but anticoagulation is always needed for _______ valve.

Aortic regurgitation usually happens in the ____ phase of cardiac cycle.

What effect does aortic regurgitation have on SV and LV volume?

Increased SV will also increase the _____ pressure, making the heart work harder and undergo _______. The cardiac oxygen consumption also ______, resulting in risk of __________.

Increased SV also results in (increased/decreased) LVET, resulting in less time for _________ and hence _________.

The effective SV of patients with aortic regurgitation __________.

Other than age, radiation, and trauma, what are the possible etiologies of aortic regurgitation? (CREAM)

List some symptoms of AR.

What are some clinical signs of AR?

What are some medical tests that can be used to confirm AR?

T/F: Aortic stenosis and aortic regurgitation have the same effective treatment.

Which medications are useful in AR patients?