2 - Cardiac Muscle Dysfunction and Failure Flashcards by Peyton Noblit

what is a common cause of congestive heart failure?

cardiac muscle dysfunction

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

dyspnea
fluid buildup
fatigue at rest and/or activity

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

heart failure

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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?

left
increased
hypertrophies
increased
vascularity
heart, kidney, brain

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Second most common cause of cardiac muscle dysfunction?

coronary artery disease

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Labs to check with MI?

CK
CK-MB
Troponin I

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main problem with cardiac arrythmias?

reduction in cardiac output

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___ ___:
- 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

cardiac arrythmias

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Labs to check after cardiac arrhythmia?

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

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___ ___ contributes/exacerbates to CMD due to fluid overload

Renal insufficiency (prescribe diuretics)

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

reduce

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

Na+ and K+

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

azotempia

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Severe renal insufficiency is caused by what 2 things?

decreased glomerular filtration rates
decreased blood flow

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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

sympathetic

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

cardiomyopathy

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what does cardiomyopathy impair of the heart muscle?

contractility and/or relaxation

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

prolonged HTN
MI
metabolic disorders: DM, thyroid disease
heart valve problems
cardiac arrhythmias

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3 types of cardiomyopathies?

dilated
hypertrophic
restrictive

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HFrEF = ____ cardiomyopathy

dilated

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

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

myocardial mitochondrial

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dilated cardiomyopathy: _____(systolic or diastolic) dysfunction

systolic

heart is less effective pump
decreased ejection fraction

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dilated cardiomyopathy has ______ left ventricular end-diastolic volume

increased

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

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

dilated (HFrEF)

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HFpEF = ____ cardiomyopathy

hypertrophic

hypertrophic cardiomyopathy: ____(systolic or diastolic) dysfunction

diastolic - impaired diastolic filling - less compliant cardiac mm - myocardium does not relax to allow filling

does hypertrophic cardiomyopathies increase or decrease left end diastolic pressure?

increase

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

increase

possible causes of hypertrophic cardiomyopathies?

1. genetic 2. prolonged HTN

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

hypertrophic cardiomyopathies

___ cardiomyopathies: - myocardial fibrosis - defect in myocardial relaxation

restrictive

is restrictive cardiomyopathy a systolic or diastolic dysfunction?

diastolic

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

myocardial hypertrophy

term for when a valve is leaky?

valvular insufficiency

term for when a valve does not open wide enough?

valvular stenosis

with valvular stenosis, will CO increase or decrease?

decrease - with decrease in CO, BP will also decrease

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

decrease AFTER A WHILE

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

regurgitant, hypertrophy, relaxation

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

pericarditis

__ ___ 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

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

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

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

mPAP > ___ mmHg for primary pulmonary hypertension

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

COPD

___ ___: term for right sided heart failure

cor pulmonale

pulmonary hypertension causes increased ____ ____ work

right ventricular

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

congestive heart failure left ventricular pulmonary edema

lab to check for CHF?

BNP

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

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

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

sympathetic epinephrine frequency

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

loss beta blockers

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

reduction alpha adrenergic catecholamine angiotensin II

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

vasoconstriction decreased increased decreased increased

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

sodium and water retention

labs for renal disease and CHF?

urea creatinine GFR

how many stages of fluid accumulation in the pulmonary system?

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

stage 1

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

stage 2

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

stage 3

labs for hepatic function and CHF?

ALT AST Ammonia

normal pulse pressure?

between 40-60

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)

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

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

- 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)

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

right

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

heart rate

_____: platelet counts under 150,000 cells/microL

thrombocytopenia

___ and ___ damage from CHF can decrease thrombin secretion

liver, kidney

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

diametet 45% lipid

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

normal atrophy I 50

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.

60-90% glucose