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CHF Simulation: Preparation Questions
1. List the risk factors for chronic left-sided heart failure
related to coronary artery disease.
The risk factors are hypertension, diabetes, elevated lipids, tobacco use, and
obesity.
2. Explain the cause of the compensations for chronic heart
failure. Question is confusing and the answer based on the words written
is chronic heart failure. Chronic heart failure causes decreases in blood flow
or ineffective blood flow mechanisms. These situations cause the body to
compensate to maintain homeostasis which the body is built to do.
1. Frank –Starling mechanism: Increases contractile force leading to
increased CO
2. Neuroendocrine responses including activation of the
sympathetic nervous system and renin-angiotensin system:
a) Decreased CO stimulates the sympathetic nervous
system and catecholamine release. Increased HR, BP,
contractility, vascular resistance, venous return.
b) Decreased CO and decreased renal perfusion stimulate renin-
angiotensin system. Vasoconstriction and increased BP
c) Angiotensin stimulates aldosterone release from adrenal
cortex. Salt and water retention by kidneys, increased vascular
volume.
d) ADH is released from posterior pituitary. Water excretion
inhibited.
e) Atrial natriuretic peptide and brain natriuretic peptide are
released. Increased sodium excretion, Diuresis,
Vasodilation.
f) Blow flow is redistributed to vital organs (heart/brain).
Decreased perfusion of other organ systems. Decreased
perfusion of skin and muscles.
3. Myocardial hypertrophy: Increased cardiac work load causes
myocardial muscle to hypertrophy and ventricles to dilate. Increased
contractile forced to maintain CO.
3. Describe the manifestations and effects of right-sided and
left-sided heart failure.
Manifestations of right-sided heart failure are RV heaves, murmurs,
jugular venous distention, edema, weight gain, increased heart rate,
ascites, anasarca, and hepatomegaly. The effects are fatigue, anxiety,
depression, depended bilateral edema, right upper quadrant pain,
anorexia and GI bloating, and nausea.
Manifestations of left-sided heart failure are L V heaves, pulsus alternans,
increased heart rate, PMI displaced inferiorly and posteriorly decreased
PaO2, slight increase PaCO2, crackles, S3 and S4 heart sounds, pleural
effusion, changes in mental status, restlessness, and confusion. The
effects are weakness, fatigue, anxiety, depression, dyspnea, shallow
respirations up to 32 -40/min, paroxysmal nocturnal dyspnea, orthopnea,
, dry hacking cough, nocturia, and frothy pink-tinged sputum.
4. List the goals in the interdisciplinary care of a patient
with chronic heart failure.
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