Cardiac Failure

Question 1

what are some causes of CHF?

Answer 1

-MI
-inadequate valves
&raquo_space; regurgitation
-external pressure
ex) pericardial effusion, cancer of the heart

Question 2

how does vitamin B deficiency cause heart failure?

Answer 2

the heart cannot pump efficiently

ex) alcoholic patients

Question 3

what is the general definition of cardiac failure?

Answer 3

Reduction in pumping ability of heart

● Due to deterioration of heart or worsening of factors external to heart (or both)

Question 4

diastolic heart failure is a ____ issue

Answer 4

filling

Question 5

systolic heart failure is a _____ issue

Answer 5

pressure

Question 6

what is the result of systolic heart failure on cardiac function?

Answer 6

weakened muscle & decreased contractility

● leads to decreased ejection fraction (EF)

Question 7

what can cause systolic heart failure?

Answer 7

● Damage to heart by infarction or ischemia

● Chronic overload (e.g. untreated HTN)

Question 8

in systolic failure, stroke volume (SV) is_______, end systolic volume (ESV) is _______

Answer 8

• decreased

- increased

Question 9

what happens to the size of the heart over time in systolic failure?

Answer 9

heart size increases due to increased filling

Question 10

what is the most common cause of diastolic heart failure?

Answer 10

hypertension

Question 11

how does hypertension cause diastolic dysfunction?`

Answer 11

● Heart wall thickens to relieve stress of chronically working against elevated aortic pressure

Question 12

in diastolic failure, there is ______ afterload which results in impaired _____ of the ventricle walls -> intraventricular volume
decreases

Answer 12

• increased

- relaxation

Question 13

diastolic heart failure is also called ______ cardiomyopathy

Answer 13

hypertrophic

Question 14

Since volume capacity of L ventricle decreased, _____ _____ of blood is pumped out to the aorta

Answer 14

smaller amount

Question 15

in diastolic failure, there is _____ contractility but the ventricle loses ______, resulting in an inability to expand

Answer 15

normal

-compliance

Question 16

EF is _____ in diastolic heart failure

Answer 16

preserved

Question 17

____ is the most common cause of right ventricular failure

Answer 17

left heart failure

Question 18

what are pulmonary causes of right ventricular failure?

Answer 18

> HTN, COPD, severe pneumonia, PE

● Due to chronic causes – cor pulmonale

Question 19

in right ventricular failure, there is _____ RV end-diastolic, atrial, and systemic venous pressures

Answer 19

increased

Question 20

how does thyrotoxicosis cause right ventricular failure?

Answer 20

stimulation of heart to work harder

> high output cause

Question 21

RV failure results in _____ in cardiac output and an accumulation of blood in ____ ventricle, _____ atrium, and _____ circulation

Answer 21

-decrease CO 
> RV
> RA 
> systemic 
(back up of blood)

Question 22

what are systemic symptoms seen in right ventricular failure?

Answer 22

• edema
• hepatosplenomegaly
• JVD

Question 23

right sided heart failure results in an inefficient way for blood to get to the _____

Answer 23

lungs

Question 24

what are some causes of left ventricular failure?

Answer 24

● MI, ischemia most common
● HTN
● Valvular
● Idiopathic dilated cardiomyopathy

Question 25

left ventricular failure results in ____ in left ventricular end-diastolic, atrial, and pulmonary pressures and ____ cardiac output

Answer 25

increased | -decreased

Question 26

where does blood accumulate when there is left ventricular failure?

Answer 26

- left ventricle - left atrium - pulmonary circulation

Question 27

in right sided heart failure, what are some examples of GI tract congestion?

Answer 27

- anorexia - GI distress - weight loss

Question 28

in right sided heart failure, there is congestion of ___ tissues which can lead to _____ edema nad ascites

Answer 28

- peripheral | - dependent

Question 29

decreased cardiac output in left heart failure can results in:

Answer 29

activity intolerance & signs of decreased tissue perfusion

Question 30

cyanosis and signs of hypoxia in left sided heart failure is due to _____ ___ ______ from pulmonary congestion

Answer 30

impaired gas exchange

Question 31

what are symptoms that pulmonary edema can cause in left sided heart failure?

Answer 31

orthopnea paroxysmal nocturnal dyspnea cough with frothy sputum

Question 32

what are some causes of high output heart failure?

Answer 32

``` ● AV fistulas ● Beriberi heart disease ● Paget’s Disease ● Hyperthyroidism ● Pregnancy ● Anemia ● Sepsis ```

Question 33

what are the physiologic processes that result in high output cardiac failure?

Answer 33

> excessive venous return | > heart cannot meet metabolic needs

Question 34

what are causes of low output heart failure?

Answer 34

● CAD | ● cardiomyopathy

Question 35

what are the physiologic processes that result in low output cardiac failure?

Answer 35

disorders that reduce/decrease pumping ability of the heart

Question 36

an endothelin compensatory mechanism for heart failure is by amino acid peptide stimulation by ____ & ___ (receptor/hormone) which increases mechanical stress, resulting in an increase of ___ release from the SR

Answer 36

ACE & antidiuretic hormone (ADH) | -calcium

Question 37

inflammatory mediators such as ___ and ___ enhance neurohormonal activity when the heart tries to compensate in heart failure

Answer 37

TNF & interleuken

Question 38

structural changes in heart failure are compensatory responses which include:

Answer 38

● Myocardial Hypertrophy & Remodeling