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Cardiopulm > 2 - Cardiac Muscle Dysfunction and Failure > Flashcards

2 - Cardiac Muscle Dysfunction and Failure Flashcards

1
Q

what is a common cause of congestive heart failure?

A

cardiac muscle dysfunction

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2
Q

Cardiac muscle dysfunction is usually asymptomatic and progress to symptoms of heart failure, including what 3 things?

A
  1. dyspnea
  2. fluid buildup
  3. fatigue at rest and/or activity
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3
Q

what is the most common cause of pulmonary congestion and edema?

A

heart failure

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4
Q

HYPERTENSION:
- increased arterial pressure increases work on the ___ ventricle
- ___ afterload
- left ventricle enlarges and ____
- ___ energy expenditure of the mm fibers
- no increase in ____
- increased risk of macro and microvascular damage to major organs, particularly which 3?

A
  • left
  • increased
  • hypertrophies
  • increased
  • vascularity
  • heart, kidney, brain
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5
Q

Second most common cause of cardiac muscle dysfunction?

A

coronary artery disease

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6
Q

Labs to check with MI?

A
  1. CK
  2. CK-MB
  3. Troponin I
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7
Q

main problem with cardiac arrythmias?

A

reduction in cardiac output

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8
Q

___ ___:
- abnormal rate and contractions of atria and/or ventricles
- altered sequence of contraction does not allow for proper filling and ejection of blood from their respective chamber
- conduction system is affected: SA node, AV node, right and left bundle branches, purkinje

A

cardiac arrythmias

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9
Q

Labs to check after cardiac arrhythmia?

A

electrolytes: Na, K, Cl, and then Ca, Mg

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10
Q

___ ___ contributes/exacerbates to CMD due to fluid overload

A

Renal insufficiency (prescribe diuretics)

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11
Q

principal treatment for renal insufficiency is to ___ the re-absorption of fluid at the kidneys

A

reduce

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11
Q

RENAL INSUFFICIENCY: must maintain electrolyte balance
- ___ and ___ levels
- prevent mm weakness and cardiac arrhythmias

A

Na+ and K+

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11
Q

SEVERE RENAL INSUFFICIENCY:______
- high blood content of nitrogen compounds such as urea and creatinine

A

azotempia

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11
Q

Severe renal insufficiency is caused by what 2 things?

A
  1. decreased glomerular filtration rates
  2. decreased blood flow
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12
Q

RENAL INSUFFICIENCY:
- there will be an increase in ____ nervous system activity to increase BP which causes an increase in BUN, creatinine, water and sodium retention

A

sympathetic

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13
Q

____: disease of the heart muscle itself leading to heart failure

A

cardiomyopathy

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14
Q

what does cardiomyopathy impair of the heart muscle?

A

contractility and/or relaxation

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15
Q

Cardiomyopathy can be primary or secondary. Primary causes usually due idiopathic mechanisms. Secondary is often due to what?

A
  1. prolonged HTN
  2. MI
  3. metabolic disorders: DM, thyroid disease
  4. heart valve problems
  5. cardiac arrhythmias
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16
Q

3 types of cardiomyopathies?

A
  1. dilated
  2. hypertrophic
  3. restrictive
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17
Q

HFrEF = ____ cardiomyopathy

A

dilated

HFrEF = heart failure reduced ejection fraction (reduced EF = <40%)

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18
Q

dilated cardiomyopathy is associated with ___ ___ dysfunction: decreased energy production of the myocytes

A

myocardial mitochondrial

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19
Q

dilated cardiomyopathy: _____(systolic or diastolic) dysfunction

A

systolic

  • heart is less effective pump
  • decreased ejection fraction
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20
Q

dilated cardiomyopathy has ______ left ventricular end-diastolic volume

A

increased

  • dilates and stretches cardiac mm fibers
  • decreased contractility of mm fibers due to overstretch
  • impaired frank starling mechanism
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21
Q

treatments for ___ cardiomyopathy include:
- medications
- pacemaker (biventricular pacing)/implantable defibrillator
- surgery: left ventricular assistive device or heart transplantation

A

dilated (HFrEF)

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22
Q

HFpEF = ____ cardiomyopathy

A

hypertrophic

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23
Q

hypertrophic cardiomyopathy: ____(systolic or diastolic) dysfunction

A

diastolic

  • impaired diastolic filling
  • less compliant cardiac mm
  • myocardium does not relax to allow filling
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24
Q

does hypertrophic cardiomyopathies increase or decrease left end diastolic pressure?

A

increase

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25
Q

Does hypertrophic cardiomyopathies increase or decrease left atrial, pulmonary artery and pulmonary capillary pressure?

A

increase

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26
Q

possible causes of hypertrophic cardiomyopathies?

A
  1. genetic
  2. prolonged HTN
27
Q

what is often a common cause for sudden cardiac arrest in young athletes?

A

hypertrophic cardiomyopathies

28
Q

___ cardiomyopathies:
- myocardial fibrosis
- defect in myocardial relaxation

A

restrictive

29
Q

is restrictive cardiomyopathy a systolic or diastolic dysfunction?

A

diastolic

30
Q

With heart valve abnormalities, the heart contracts more forcefully to expel the cardiac output; this will induce ____ ____

A

myocardial hypertrophy

31
Q

term for when a valve is leaky?

A

valvular insufficiency

32
Q

term for when a valve does not open wide enough?

A

valvular stenosis

33
Q

with valvular stenosis, will CO increase or decrease?

A

decrease

  • with decrease in CO, BP will also decrease
34
Q

with valvular regurgitation, will CO decrease or increase after a while?

A

decrease AFTER A WHILE

35
Q

Valvular incompetence:
- ___ blood fills atria and ventricles forcefully
- myocardial dilation and ____ ensues
- produces CMD due to impaired ____ of myocardium

A

regurgitant, hypertrophy, relaxation

36
Q

____: inflammation of the pericardium due to injury or infection; produces fluid that may compress the heart

A

pericarditis

37
Q

__ ___ is a medical or traumatic emergency that happens when enough fluid accumulates in the pericardial sac compressing the heart and leading to a decrease in cardiac output and shock

A

cardiac tamponade; symptoms include:
1. anxiety, restlessness
2. chest pain
3. difficulty breathing
4. discomfort, sometimes relieved by sitting upright or leaning forward
5. fainting, light-headedness
6. pale, blue, gray skin
7. palpitations
8. rapid breathing
9. swelling of the abdomen or other areas

38
Q

pulmonary embolism:
- may cause lung ___ due to decreased right ventricular blood flow
- covid-19 patients are at increased risk
- ____ (inc/dec) pulmonary hypertension

A

infarction
increase bc:
- further increases right ventricular work
- right ventricular hypertrophy
- decreased right ventricular SV progressing to decreased left ventricular SV and CO

39
Q

mPAP > ___ mmHg for primary pulmonary hypertension

A

20

40
Q

___:
- pulmonary artery HTN
- caused by hypoxia
- increased pulmonary vascular resistance

A

COPD

41
Q

___ ___: term for right sided heart failure

A

cor pulmonale

42
Q

pulmonary hypertension causes increased ____ ____ work

A

right ventricular

43
Q

___ ___ ___:
- pathological decrease in cardiac output
- ___ ___ failure leading to pulmonary congestion
- ____ ____ due to increased pulmonary capillary pressure

A

congestive heart failure
left ventricular
pulmonary edema

44
Q

lab to check for CHF?

A

BNP

45
Q

CHF descriptions:
- ___: fluid backup into right atrium/periphery
- ___: fluid backup into lungs (pulmonary capillary pressure >15-20mmHg)
- ____: bi-ventricular: fluid backup into lungs increases pulmonary artery pressure, progresses to right ventricular failure
- ___ ___: low SV due to decreased ventricular contraction
- ___ ___: impaired ability for ventricles to accept blood at rest or activity

A

right
left
bilateral
systolic dysfunction (HFrEF)
diastolic dysfunction (HFpEF)

46
Q

Myocardial contractility is positively affected by increased:
- _____ nerve impulses
- circulating ___
- ___ of contractions
- use of pharmacologic agents such as digitalis and lanoxin

A

sympathetic
epinephrine
frequency

47
Q

Myocardial contractility is negatively affected by increased:
- ___ of myocardial cells
- pharmacologic depressants such as ___ ___
- acidosis
- hypercapnia
- anoxia

A

loss
beta blockers

48
Q

RENAL FUNCTION AND CHF:
- arterial sensors in the renal and nonrenal systems senses ____ in blood volume
- increased ___ _____ neural activity
- increased ____ circulation
- increased ____ ___ production

A

reduction
alpha adrenergic
catecholamine
angiotensin II

49
Q

with increased angiotensin II production:
- renal ___
- ____ GFR and renal blood flow
- ___ renal filtration fraction (ratio of GFR to renal blood flow)
- ____ urine production
- ______ BUN and serum creatinine levels resulting in azotempia

A

vasoconstriction
decreased
increased
decreased
increased

50
Q

Overall effect with renal function and CHF is to increase CO and BP by what?

A

sodium and water retention

51
Q

labs for renal disease and CHF?

A

urea
creatinine
GFR

52
Q

how many stages of fluid accumulation in the pulmonary system?

A

3

53
Q

what stage of fluid accumulation?
- increased lymph flow w/o net gain in interstitial fluid. Gas exchange is improved. Increased lymph flow increases liquid into the lung

A

stage 1

54
Q

what stage of fluid accumulation?
- liquid build up compromises small airways of lung. ventilation/perfusion mismatch. produces hypoxemia and tachypnea

A

stage 2

55
Q

what stage of fluid accumulation?
- pulmonary edema increases, increased capillary wedge pressure that floods the alveoli. compromises gas exchange. produces severe hypercapnea and hypoxemia

A

stage 3

56
Q

labs for hepatic function and CHF?

A

ALT
AST
Ammonia

57
Q

normal pulse pressure?

A

between 40-60

58
Q

What happens when there is a decreased oxygen concentration in the blood due to either right and/or left heart failure? (related to hematologic function)

A

Decreased oxygen concentration causes erythropoietin production in the renal cortex to increase which increases red blood cell production from bone marrow

effects:
- polycythemia
- increased blood volume
- leads to exacerbation of an already compromised CV system

59
Q

how can anemia help and hurt an already compromised CV system?

A
  • anemia (low hematocrit/hemoglobin) can cause CHF by itself
  • anemia may be useful when CHF is present as CO is decreased due to decreased blood viscosity leading to decreased BP and reduced afterload on the ventricles (however lower arterial oxygen concentration and lower oxygen saturation)
60
Q

which direction does anemia shift the hemoglobin-oxygen dissociation curve?

A

right

61
Q

severe anemia treated by blood transfusions may decrease CO due to decreased ___ ____

A

heart rate

62
Q

_____: platelet counts under 150,000 cells/microL

A

thrombocytopenia

63
Q

___ and ___ damage from CHF can decrease thrombin secretion

A

liver, kidney

64
Q

SKELETAL MM ACTIVITY AND CHF W/O CARDIOMYOPATHY:
- decreased type I and type II mm fiber ___
- decreased normal isometric maximal voluntary contraction by an average of ___% of quadriceps
- increased intracellular ___ accumulation
- increased mm fatigue due to: intracellular acidosis, decreased phosphocreatine levels

A

diametet
45%
lipid

65
Q

SKELETAL MM ACTIVITY AND CHF WITH CARDIOMYOPATHY (DILATED OR HYPERTROPHIC)
- ___ nerve conduction and motor unit potential
- type I and II mm fiber ____
- mitochondrial abnormalities in type __ mm fibers
- decreased maximal isometric mm by __% as compared to age, sex and weight matched controls
- increased mm fatigue
- increased relative mm output at any given workload

A

normal
atrophy
I
50

66
Q

Normally, ___% of fuel to pump blood is obtained by the oxidation of fatty acids when O2 is present. Dysfunctional heart relies on ___ as primary fuel source.

A

60-90%
glucose

67
Q
A

Cardiopulm (3 decks)

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