13. Heart Failure I: Pathophys Flashcards
What can cause volume overloaded heart muscle?
mitral regurg high cardiac output holes in heart beriberi
What can cause cardiac muscle cell destruction?
MI viral myocarditis peripartum cardiomyopathy idiopathic cardiomyopathy alcohol
What does HFpEF stand for?
HF with preserved ejection fraction
What does PSF stand for?
preserved systolic function
What affects the stroke volume?
contractility, preload, afterload
What is systolic HF?
a problem with the squeeze; ↓contraction / ↓ inotropy decreased ejection fraction and ventricular enlargement can be heart failure with reduced ejection fraction (HFrEF), left ventricular systolic dysfunction (LVSD), or dilated cardiomyopathy (DCM)
What can cause overstressed heart muscle?
tachycardia-mediated HF meth abuse catecholamine mediated
What can cause myocardial thickening/fibrosis?
hypertrophic cardiomyopathy 1a restrictive cardiomyopathy
What are the 1a causes of R heart failure?
- L sided heart failure 2. lung disease/pulmonary HTN 3. RV volume overload 4. damage to the RV myocardium
For patients with symptomatic HF, half will be dead within _____.
5 years
What are the hallmarks of diastolic HF?
- normal ejection fraction (“HF with preserved ejection fraction” = HFpEF; “preserved systolic function” = PSF) 2. ventricular wall thickening (LVH, HCM)
What does DCM stand for?
dilated cardiomyopathy
Most heart failure involves?
the L heart
What are the 2 main components of HF?
poor forward blood flow (↓ cardiac output) and backward buildup of pressure/congestion (↑ filling pressures)
What is cor pulmonale?
when 1a lung disease causes HF
What is the outcome of RAAS activation?
o Vascoconstriction o Salt/water retention
A hypertrophied heart has ____ HF; a dilated heart has ____ HF.
hypertrophy = diastolic dilated = systolic
What determines inotropy?
o Catecholaminergic / adrenergic stimulation o Calcium
What can cause high afterload/pressure overload?
hypertension aortic stenosis dialysis (inadequate fluid removal)
Name 4 adverse cardiac remodeling outcomes caused by long term increased cardiac workload and metabolic demands.
o Ventricular hypertrophy o Ventricular dilation o Myocardial damage / apoptosis o Myocardial fibrosis
Name 2 ways the RV myocardium can get damaged.
- isolated RV infarct 2. myocarditis
Heart failure is ______ to meet the metabolic demands of the body (forward failure), or the ability to do so only if the cardiac filling pressures are abnormally high (backward failure).
the inability of the heart to pump blood forward at a sufficient rate
o Vascoconstriction o Salt/water retention These are caused by?
RAAS activation
What does LVSD stand for?
left ventricular systolic dysfunction
Problems with relaxation cause problems with ____ (↓lusitropy / decrease in relaxation).
filling
What can cause external compression?
pericardial fibrosis/constructive pericarditis pericardial effusion
Heart failure is the inability of the heart to pump blood forward at a sufficient rate to _____ (forward failure), or the ability to do so only if the cardiac filling pressures are abnormally high (backward failure).
meet the metabolic demands of the body
Name 3 general causes of diastolic heart failure.
- high afterload/pressure overload 2. myocardial thickening/fibrosis 3. external compression
What does HCM stand for?
hypertrophic cardiomyopathy
What does LVH stand for?
left ventricular hypertrophy
Heart failure is the inability of the heart to pump blood forward at a sufficient rate to meet the metabolic demands of the body (forward failure), or the ability to do so only if the cardiac filling pressures are ____ (backward failure).
abnormally high
What does HFrEF stand for?
heart failure with reduced ejection fraction
HFrER, LVSD, and DCM are all?
systolic HF
The median age for CF pts is ___.
75yo
o Vasocontriction o Tachycardia o Inotropic augmentation All are caused by?
adrenergic activation
What is the outcome of adrenergic activation?
o Vasocontriction o Tachycardia o Inotropic augmentation
What causes systolic HF?
o destruction of heart muscle cells (MI, viral myocarditis, peripartum cardiomyopathy, idiopathic cardiomyopathy, alcohol) o overstressed heart muscle (tachycardia-mediated HF, meth abuse, catecholamine mediated) o volume overloaded heart muscle (mitral regurg, high cardiac output, holes in heart, beriberi)
