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Pathophysiology > Adult Cardio 5 (Heart Failure) > Flashcards

Adult Cardio 5 (Heart Failure) Flashcards

1
Q

Approximately __ million patients in the US have heart failure

A

6

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2
Q

Over ____ patients are diagnosed with heart failure for the first time each year

A

550,000

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3
Q

Heart failure is the primary reason for __-__ million office visits and 6.5 million hospital days each year

A

12-15

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4
Q

Heart failure is the most common ____ diagnosis-related group

A

Medicare

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5
Q

In 2009, ____ patients died of heart failure as a primary/secondary cause

A

275,000

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6
Q

In incidence of heart failure approaches ___ per 1000 people after the age of 65

A

10

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7
Q

More dollars are spent for the diagnosis and treatment of heart failure than any other ___ by Medicare (2007: $33 billion)

A

Diagnosis

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8
Q

Before age 80, do males or females have a higher prevalence of heart failure?

A

Males

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9
Q

After age 80, ____ have a higher prevalence of heart failure

A

Females

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10
Q

Risk factors for heart failure:

A

-Hypertension
-Myocardial infarction
-Diabetes
-Obesity
-Idiopathic cardiomyopathy
-Infection (e.g., viral myocarditis)
-Old age/male sex/AA
-Abnormal conduction (Left bundle branch block)
-Heart valve disease
-Prolonged arrhythmias
-Toxins (alcohol, cytotoxic drugs, etc.)

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11
Q

Although heart failure is a major public health problem, there are no national ___ ___ to detect the disease at its earlier stages

A

Screening efforts

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12
Q

Heart failure is largely ____, primarily through the control of blood pressure and other vascular risk factors

A

Preventable

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13
Q

Until recently, however, the factors that render a patient at a high risk for heart failure has not been clearly ___ or ___

A

Defined/publicized

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14
Q

Staging of heart failure is necessary for targeting therapy and improving the ___ ___ ___

A

Quality of life

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15
Q

Heart failure is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to ___ with (diastolic) or ___ blood (systolic)

A

Fill/eject

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16
Q

Since not all patients have ___ ___ at the time of initial or subsequent evaluation, the term “heart failure” is preferred over the older term “congestive heart failure”

A

Volume overload

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17
Q

Heart failure is not a disease by itself, but rather a manifestations of various ___ ___

A

Cardiac diseases

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18
Q

The clinical syndrome is characterized by the reduced ability of the heart to…

A

-Fill with blood (diastole)
-Eject blood (systole)

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19
Q

What happens when the right side of the heart fails?

A

-More blood will back up to the body causing edema
-Less blood will be ejected to the lungs, causing deoxygenation

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20
Q

What happens when the left side of the heart fails?

A

-More blood will back up to the lungs, causing pulmonary edema and shortness of breath
-Less blood will be ejected to the body, causing activity intolerance and fatigue
-Vital organs (brain and kidney) will receive less blood

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21
Q

Heart failure can lead to pressure build-up, which causes symptoms like…

A

-Difficulty breathing
-Ascites
-Peripheral edema

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22
Q

Heart failure can also cause poor pumping which can lead to symptoms like…

A

-Neurological problems
-Reduced urine output
-Fatigue

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23
Q

Currently, a complex blend of structural, functional, and biologic alterations are evoked to account for the ____ nature of heart failure and to explain the efficacy or failure of therapies used in clinical trials

A

Progressive

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24
Q

The rationale for the use of ___-___ in a patient with a poorly contracting heart is based on a conceptual framework broader than that which suggests the treatment of congestion with diuretics or digoxin

A

Beta-blockers

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25
Q

The New York Heart Association (NYHA) classifies stages of heart failure based on…

A

Functional limitations

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26
Q

NYHA class I of heart failure characteristics:

A

-No limitation on physical activity
-No overt symptoms

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27
Q

NYHA class II of heart failure characteristics:

A

-Slight limitation on physical activities
-Comfortable at rest, but ordinary physical activity causes symptoms of heart failure

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28
Q

NYHA class III of heart failure:

A

-Marked limitations on physical activities
-Comfortable at rest, but less than ordinary activity causes symptoms of heart failure

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29
Q

NYHA class IV of heart failure:

A

-Inability to carry on any activity without symptoms
-Presence of symptoms even at rest

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30
Q

Stages A-D of heart failure classify heart failure based on ___ ___

A

Structural abnormalities

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31
Q

Stage A of heart failure:

A

At high risk for heart failure but without structural heart disease or symptoms of heart failure

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32
Q

Stage B of heart failure:

A

Structural heart disease but without signs or symptoms of heart failure

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33
Q

Stage C of heart failure:

A

Structural heart disease with prior or current symptoms

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34
Q

Stage D of heart failure:

A

Advanced heart failure

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35
Q

Treatment for those with Stage A HF:

A

-Risk-factor reductions
-Patient and family education

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36
Q

Treatment for stage B HF:

A

-ACE Inhibitors or ARBs in all patients
-Beta-blockers in selected patients

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37
Q

Treatment for stage C HF:

A

ACE inhibitors and beta-blockers in all patients

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38
Q

Treatment for stage D HF:

A

Inotrope drugs

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39
Q

What neurohormonal concepts can impact systolic heart failure?

A

-Renin-Angiotensin-Aldosterone System
-Sympathetic nervous system

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40
Q

What structural abnormalities can impact systolic heart failure?

A

-Myocardial remodeling
-Cardiomyopathy
-Mitral regurgitation
-Arrhythmia and BBB

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41
Q

What are the short-term effects of salt and water retention?

A

Augments preload

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42
Q

What are long-term effects of salt and water retention?

A

-Pulmonary congestion
-Anasarca

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43
Q

What are the short-term effects of vasoconstriction?

A

Maintains blood pressure for perfusion of vital organs

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44
Q

What are the long-term effects of vasoconstriction?

A

-Exacerbates pump dysfunction (excessive afterload)
-Increases cardiac energy expenditure

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45
Q

What are the short-term effects of sympathetic stimulation?

A

Increases heart rate and ejection

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46
Q

What are the long-term effects of sympathetic stimulation?

A

Increases energy expenditure

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47
Q

What are the negative effects of catecholamines?

A

-Directly toxic
-Induces myocyte apoptosis
-Myocardial remodeling
-Down-regulation of adrenergic receptors
-Facilitate arrythmias
-Potentiation of autoimmune effects

48
Q

Negative effects of aldosterone:

A

-Myocardial fibrosis
-Autonomic dysfunction
-Dysrhythmias

49
Q

Negative effects of angiotensin II:

A

-Directly toxic to myocardium
-Mediates remodeling of ventricular wall
-Loss of contractility
-Associated with increased mortality

50
Q

Negative effects of vasopressin:

A

-Antidiuretic hormone
-Exacerbates hyponatremia and edema

51
Q

Steps of heart failure progression:

A

-Increased peripheral vascular resistance
-Increased resistance to ventricular ejection (afterload)
-Increased workload for the left ventricle
-Neurohumoral changes (RAA and SNS)
-Hypertrophy
-Increased myocyte demand for oxygen (relative ischemia)
-Ventricular remodeling
-Decreased contractility (decreased cardiac output and underperfusion of vital tissues)

52
Q

Increased levels of circulating ____ are only part of the response seen in heart failure

A

Neurohormones

53
Q

Left ventricular ___ is the process by which mechanical, neurohormonal, and possibly genetic factors alter ventricular size, shape, and function

A

Remodeling

54
Q

Hallmarks of remodeling include…

A

-Hypertrophy
-Loss of myocytes
-Increased interstitial fibrosis

55
Q

After a myocardial infarction, the acute loss of myocardial cells results in abnormal loading conditions that involve not only the border zone of the infarction, but also the ___ ___

A

Remote myocardium

56
Q

These abnormal loading conditions induce ____ and change the shape of the ventricle, rendering it more spherical, as well as causing hypertrophy

A

Dilation

57
Q

Remodeling continues for ____ after the initial insult, and the eventual change in the shape of the ventricle becomes harmful to the overall function of the heart as a pump

A

Months

58
Q

The primary problem that causes remodeling is __ ___, which leads to lowered stroke volume, increased left ventricular end-diastolic volume, cardiac dilation, and increased preload

A

Impaired contractility

59
Q

Preload (LVEDV) increases with…

A

-Decreased contractility
-Increased plasma volume

60
Q

Increased afterload causes…

A

-Low perfusion
-Increased peripheral vascular resistance
-Increased myocardial workload
-Increased Mv02 in the face of decreased myocardial oxygen delivery

61
Q

Ventricular remodeling is when a chronic intracellular state of ____ results in progressive myocyte contractile dysfunction (cellular hypertrophy and collagen deposition between cells)

A

Hypoxia

62
Q

Remodeling precedes symptoms, continues after symptoms, and worsens symptoms despite ____

A

Treatment

63
Q

Several trials involving patients who were studied after a myocardial infarction or who had dilated cardiomyopathy found a benefit from…

A

-ACE inhibitors
-Beta-adrenergic antagonists
-Cardiac resynchronization

64
Q

Such beneficial effects were associated with so-called ___ ___, in which the therapy promoted a return to a more normal ventricular size and shape

A

Reverse remodeling

65
Q

The reverse-modeling process is a mechanism through which a variety of treatments palliate ___ ___

A

Heart failure

66
Q

____ refers to diseases of the heart muscle where it becomes enlarged, thick, or rigid (in rare cases, the muscle tissue in the heart is replaced with scar tissue)

A

Cardiomyopathy

67
Q

As cardiomyopathy worsens, the heart becomes ___ and is less able to pump blood through the body and maintain a normal electrical rhythm

A

Weaker

68
Q

In cardiomyopathy, the process of progressive ___ ___ or ___ occurs without the initial apparent myocardial injury (e.g. MI)

A

Progressive ventricular dilation or hypertrophy

69
Q

What are the three types of cardiomyopathy?

A

-Dilated
-Hypertrophic
-Restrictive

70
Q

In dilated cardiomyopathy, the ventricles ____

A

Enlarge

71
Q

In hypertrophic cardiomyopathy, the walls of the ventricles ___ and become ___

A

Thicken; stiff

72
Q

In restrictive cardiomyopathy, the walls of the ventricles still become ___, but don’t necessarily thicken

A

Stiff

73
Q

Dilated cardiomyopathy is responsible for ___ deaths and ____ hospitalizations

A

10,000; 46,000

74
Q

Dilated cardiomyopathy is most common in ___ age

A

Middle

75
Q

Is dilated cardiomyopathy more common in men wor women?

A

Men

76
Q

Idiopathic dilated cardiomyopathy is a primary indication for ___ ___

A

Cardiac transplant

77
Q

Etiology of dilated cardiomyopathy:

A

-Idiopathic
-Alcohol
-Myocarditis
-IHD, VHD
-Postpartum
-Radiation therapy
-Chemotherapy (doxorubicin, daunorubicin)
-Genetic
-Cocaine abuse
-Connective tissue diseases
-Neuromuscular diseases
-Sarcoidosis, hemochromatosis
-Pheochromocytoma

78
Q

Pathophysiology of dilated cardiomyopathy:

A

-Injured myocytes replaced by connective tissue
-Myocardial fibers lengthen and ventricles dilate
-CO falls and left ventricle filling pressure rise
-Heart failure ensues
-Dilation of one or both ventricles
-Primary consequence-systolic dysfunction
-Progressive deterioration
-Poor prognosis

79
Q

Consequences of dilated cardiomyopathy:

A

-Decreased ejection fraction
-Increased end-diastolic and residual volumes
-Decreased ventricular stroke work
-Biventricular heart failure

80
Q

Signs and symptoms of dilated cardiomyopathy:

A

-Dyspnea due to pulmonary congestion
-Fatigue
-Palpitations
-Systemic and pulmonary emboli
-Chest pain
-Extra heart sounds and murmurs

81
Q

Hypertrophic cardiomyopathy can be seen in ___-___% of people (1 in 350-624 people)

A

0.16-0.29%

82
Q

Etiology of hypertrophic cardiomyopathy:

A

-Genetic disease of cardiac sarcomere (autosomal dominant patterns of inheritance)
-Myocardial hypertrophy (small or normal ventricular cavity, hyperdynamic ventricular function, diastolic dysfunction)
-Can be classified as either obstructive or nonobstructive

83
Q

Pathophysiology of hypertrophic cardiomyopathy:

A

-Systolic function: hallmark is hypercontractility; normal cardiac output; ejection fraction is higher than normal
-Primary consequence is diastolic dysfunction (reduced distensibility and compliance)

84
Q

Consequences of hypertrophic cardiomyopathy:

A

-Asymmetric thickening
-Disproportionate septal thickening
-Abnormalities of collagen deposition and altered contractile proteins in myocytes
-Hperdyanmic state (increased contractility and ejection fraction)
-Impaired diastolic relaxation- ventricles can’t fill

85
Q

Signs and symptoms of hypertrophic cardiomyopathy:

A

-Sudden onset of VT or VF
-Angina
-Syncope
-Palpitations
-LV heart failure
-MI can occur if ventricular myocardium outgrows its blood supply

86
Q

Restrictive cardiomyopathy has a greater incidence in the ___ population, especially in ___

A

Elderly; women

87
Q

Etiology of restrictive cardiomyopathy:

A

-Idiopathic
-Familiar
-Amyloidosis
-Inborn metabolic errors
-Hemachromatosis
-Sarcoidosis
-Radiation

88
Q

Pathophysiology of restrictive cardiomyopathy:

A

-Primary consequence: diastolic dysfunction
-Non-dilated ventricle with normal wall thickness
-Ventricular walls are rigid (severe diastolic dysfunction causing elevated filling pressures and dilate atria)
-Normal left ventricle systolic function

89
Q

Consequences of restrictive cardiomyopathy:

A

-Myocardium becomes rigid and non-compliant
-Impedes ventricular filling (diastolic dysfunction)
-Impaired contractility (Systolic dysfunction)

90
Q

Signs and symptoms of restrictive cardiomyopathy:

A

-Exercise intolerance
-Weakness
-Dyspnea
-Edema
-Heart failure
-Dysrhythmias

91
Q

___ ___ is a deleterious outcome of remodeling

A

Mitral regurgitation

92
Q

With mitral regurgitation, as the left ventricle dilates and the heart assumes a more globular shape, the geometric relationship between the papillary muscles and the mitral leaflets changes, causing ___ ___ and ___ ___ of the leaflets and distortion of the mitral apparatus

A

Restricted opening and increased tethering

93
Q

Dilation of the annulus occurs as a result of increasing left ventricular or atrial size or as a result of regional abnormalities caused by ___ ___

A

Myocardial infarction

94
Q

The presence of mitral regurgitation results in an increasing volume overload on the overburdened ___ ___ that further contributes to remodeling, the progression of the disease, and symptoms

A

Left ventricle

95
Q

___ ___ (arrhythmia) is the primary precipitating event that happens before the onset of heart failure

A

Atrial fibrillation

96
Q

Atrial fibrillation is a very rapid ___ ___ due to the chaotic and irregular contraction of the atria

A

Heart rate

97
Q

The contraction of the atria is out of coordination with the hat of the ____, resulting in improper and inefficient cardiac cycle

A

Ventricles

98
Q

Episodes of atrial fibrillation may be ___ or ____

A

Persistent or intermittent

99
Q

With arrhythmias, elevated end-diastolic pressure in a patient with hypertension or abnormal myocardial function leads to ___ ___, which in turn incites electrical instability

A

Atrial stretch

100
Q

Atrial fibrillation further compromises ___ ___, leading to aggravating neurohormonal compensatory mechanisms and subsequent cardiac compromise and remodeling

A

Cardiac output

101
Q

A ___ ___ ___ (BBB) is a result of altered conduction properties observed in response to ischemia, inflammation, fibrosis, and aging

A

Bundle branch block

102
Q

The presence of a BBB also affects the mechanical events of the cardiac cycle by causing…

A

-Abnormal ventricular activation and contraction
-Ventricular dyssynchrony
-Delayed opening and closure of the mitral and aortic valves
-Abnormal diastolic function

103
Q

Pathophysiology of a BBB:

A

-Reduced ejection fraction
-Decreased cardiac output and atrial pressure
-Increased left ventricular volume
-Mitral regurgitation
-Inhomogenous activation
-Paradoxical septal motion
-Repetitive ventricular contractions
-Ventricular repolarization dispersion
-Ventricular arrhythmias
-Sudden cardiac death

104
Q

It is estimated that 20-50% of patients with heart failure have preserved ___ function or a normal ___ ___ ___ ___

A

Systolic; left ventricular ejection fraction

105
Q

Although such heart contracts normally, ____ is abnormal and it occurs singly or in combination with systolic heart failure

A

Relaxation (diastole)

106
Q

With diastolic heart failure, ___ ___, especially during exercise, is limited by the abnormal filling characteristics of the ventricles

A

Cardiac output

107
Q

The result of diastolic heart failure is elevated ___ ___ and subsequent ___ ___ despite normal stroke volume and cardiac output

A

Ventricular pressure, pulmonary congestion

108
Q

Causes of diastolic heart failure:

A

-Hypertension (myocardial hypertrophy)
-Myocardial ischemia (ventricular remodeling)
-Diabetes
-Diseases of aortic valve, mitral valve, or pericardium
-Cardiomyopathies

109
Q

With diastolic heart failure, there is decreased compliance, and abnormal ___ ___

A

Diastolic relaxation

110
Q

With diastolic heart failure, normal left ventricular end-diastolic volume causes increased…

A

Left ventricular end-diastolic pressure

111
Q

Diastolic heart failure is manifested as…

A

-Dyspnea on exertion
-Fatigue
-Pulmonary edema
-Pleural effusions

112
Q

Systolic heart failure affects people of all ages (typically age 50-70), while diastolic heart failure frequently affects ____ people

A

Elderly

113
Q

Diastolic HF is more common in ___ while systolic HF is more common in ___

A

Female; Male

114
Q

Left ventricular ejection fraction is ___ or ___ with diastolic heart failure, but depressed with systolic HF

A

Preserved or normal

115
Q

Left ventricular cavity size is usually ____ with diastolic HF but ___ with systolic HF

A

Normal; dilated

116
Q

Since no one single pathophysiological model can account for the host of clinical expressions of heart failure, current therapy often targets more than one ___ ___

A

Organ system

Pathophysiology (18 decks)

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