UWorld- Cardio Phys Question

[fuzzywuz]

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There was this question that only 17% answered correctly. It was a question that asked for the changes in LV (normal or dilated), LVEF (inc or dec or nl), LVEDP (inc or dec or nl) for a pt w/ DIASTOLIC HEART FAILURE?

Can someone explain what the answer is? I have the answer and its below ( just in case you guys wanna think it thru)




Ans: LV cavity = normal, LVEF = normal, LVEDP = inc


My big issue is why LVEF is whatever they put.

Thanks!

 

[ThereHeIs]

There was this question that only 17% answered correctly. It was a question that asked for the changes in LV (normal or dilated), LVEF (inc or dec or nl), LVEDP (inc or dec or nl) for a pt w/ DIASTOLIC HEART FAILURE?

Can someone explain what the answer is? I have the answer and its below ( just in case you guys wanna think it thru)




Ans: LV cavity = normal, LVEF = normal, LVEDP = inc


My big issue is why LVEF is whatever they put.

Thanks!

We learned that fact in pathophys and I never really knew why, its just one of those things I accepted. It came up on our exam, a similiar up down arrow type deal and I immediately eliminated most answer choices based on that fact lol

 

[kstreet]

Question ID 186:

The heart has a pathologic decrease in compliance, so LVEDV SV and CO are all decreased. Heart size is going to be normal because this is a restrictive type of cardiomyopathy. EF is normal because EF=SV/EDV and both suck, but the percentage will remain the same.

I think LVEDP is increased because the same amount of blood is trying to enter a smaller amount of space and the heart can't properly fill because it's being stopped by fibrous tissue or some other restrictive dz.

 

[fuzzywuz]

Yeah, I was thinking that too. But what really trips me is this:

"LV systolic failure implies stroke volume and CO are reduced at a normal LVEDV" (Okay, that makes sense... heart can't squeeze out blood.)

"The FS curve relating SV to LVEDV, and therefore EF, is depressed." (Again, that makes sense as EF = SV/LVEDV)

"To maintain a near normal CO, both LVEDV and thus lVEDP must be abnormally increased." (Didn't they just say LVEDV is normal? I get why LVEDV is increased. Afterall, systolic HF means LV is dilated. But why would they say LVEDV is NORMAL and now say its INCREASED?)

 

[Step1Hash]

I just got to this question and I think i see what they mean. So with diastolic HF you have decreased compliance in the ventricle. Therefore there is less volume in the heart to keep the same LVEDP. But to maintain a near normal CO you need to have a near normal volume in the ventricle at the end of diastole and thus in doing so you have to increase LVEDP above normal.

 

[fuzzywuz]

Yeah it does make more sense now. The only thing is.. I guess to answer this question, you also have to assume the heart can still compensate and bring EF back to normal and that the LV isn't too stiff to prevent compensated filling.

 

[Step1Hash]

Yeah it does make more sense now. The only thing is.. I guess to answer this question, you also have to assume the heart can still compensate and bring EF back to normal and that the LV isn't too stiff to prevent compensated filling.

Yea I think you assume that bc his HR is 80 and he isn't tachycardic and not trying to compensate for a decreased CO. Thats my guess.