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Physiology I Block 4 > Cardiac Failure > Flashcards

Cardiac Failure Flashcards

1
Q

one of the major causes of cardiac failure is

A

ischemic heart disease

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2
Q

what does heart failure mean

A

any heart condition that reduces ability of heart to pump enough blood to meet body’s needs

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3
Q

congestive heart failure

A

regular heart failure that also has congestion

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4
Q

any valvular defect can lead to

A

heart failure

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5
Q

just because you have coronary artery disease, or mitral regurtigation, or aortic stenosis, etc. doesn’t mean you have

A

heart failure

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6
Q

presence of cardiac disease does not mean your heart is

A

in failure

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7
Q

when cardiac disease progress to where heart cannot meet needs of the body, it becomes

A

failure

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8
Q

disease can lead to failure but

A

the disease itself doesn’t meant you are in failure

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9
Q

primary cardiac disease are the

A

myopathies - like dilated cardiomyopathy

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10
Q

primary cardiac disease are disease of

A

the muscle themselves

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11
Q

valvular defect, there isn’t anything wrong with the muscle -

A

the valve problem is what causes the problem with the muscle

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12
Q

what are the acute effects of moderate cardiac failure

A

reduced CO

damming of blood in the veins

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13
Q

why does atrial pressure increase after cardiac failure

A

blood is returning but the heart can’t pump enough out - so you get damming of veins

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14
Q

why do you get damming of veins b/c of moderate cardiac failure

A

heart can’t pum pout enough

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15
Q

right after heart is damaged what isfrst compensatory mechanism you see

A

sympathetic nervous system

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16
Q

describe sympathetic compensation after cardiac failure

A

Baroreceptor reflex, chemoreceptor reflex, CNS ischemic response(if really bad).
Increase rate and force (functional muscle)
Increase in venous return

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17
Q

what happens to cardiac function curve after compensation

A

it is going to move back up b/c of the compensation (see pg 4)

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18
Q

how much the cardiac function curve moves up after cardiac failure depends on

A

how much damage was caused

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19
Q

what two things happen in chronic stage of failure

A

retention of fluid by kidney

cardiac remodeling

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20
Q

why is there retention of fluid by kidney

cardiac remodeling in chronic stage of failure

A

to reach the critical cardiac output level for normal fluid balance

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21
Q

what happens in kidney during hcronic stage failure to increase fluid retention

A

decreased glomerular filtration
actiation of renin-angiotensin system
increased aldosterone secretion

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22
Q

moderate fluid retention in cardiac failure is beneficial - why?

A

increase in venous return to help compensate for dimnished pumping ability of heart

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23
Q

body is trying to reabsorb fluids to stretch heart to

A

make it better pump and bring CO to normal level

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24
Q

if fluid retention gets to point where CO is normal, then

A

the body won’t retain more fluid

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25
Q

too much fluid retention in response to cardiac fauilre is

A

bad - fine line b/w how much is god and how much is bad

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26
Q

if there is too mjuch fluid in severe cardiac failure what could happen

A

overstretch the heart - this is BAD

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27
Q

b/c of the too much fluid in severe cardiac failure what could happen in lungs

A

filtration of fluid into the lungs, causing pulmonary edema and because of that deoxygenation of blood

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28
Q

if you have too much fluid in severe cardiac filuare what coul dhappen inrest of body

A

edema

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29
Q

collateral circulation will being to penetrate the peripheral portions of the infarcted area of the

A

heart

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30
Q

what happens to the muscle part of undamged portion of heart after MI

A

hypertrophy

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31
Q

what happens to infarcted area of heart after MI

A

collateral blood supply penetrates the peripheral portions of infarcted heart

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32
Q

what do you see in compensated heart failure

A

normal cardiac output at rest

higher than normal right atrial pressure

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33
Q

in compensated heart failure there is normal CO but

A

it takes a lot more stretching of the heart to do it and a lot of fluid retention

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34
Q

in compensated heart failure you see reduced

A

cardiac reserve

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35
Q

a person in compensated heart failur eis fine at rest, but

A

exercise is a problem b/c there are reduced cardiac reserves. you have gotten the CO to where it needs to be, but any more need and the heart an’t keep up

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36
Q

cardiac disease moving into failure you will always see what immediate effect

A

increase sympathetic nervous stimulation

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37
Q

wwhat is the intermediate phase of compensated heart failure

A

reabsorption of fluid by kidneys

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38
Q

reabsorption of fluid by kidneys - what three things do we see happen in kidney

A
  1. Decreased glomerular filtration
  2. Increased renin angiotensin system
  3. Increased aldosterone secretion
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39
Q

what is the final thing you will always see in heart failure

A

remodeling of the heart

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40
Q

what two things can you see in remodeling of th eheart

A

Collateral blood supply

Hypertrophy

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41
Q

in pt with decreased sympathetic activity compared to when the heart fialed b/c they are at normal CO and arterial pressure, sympathetic stimulation may lessen depending on

A

what it needs to be at to hav normal CO

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42
Q

left side heart failure will often lead to

A

right side failure

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43
Q

right side failure leads to

A

congestion of peripheral tissues

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44
Q

what will you see in right side heart failure

A

liver congestion
fluid in abdomen (ascites)
GI congestion

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45
Q

what congenital problems can lead to right side heart failure

A

pulmonary hypertension & tetrology of fallot

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46
Q

acute left side heart failure can occur how quickly

A

minutes

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47
Q

acute left side heart failure causes rapid

A

congestion of lungs and pulmonary edema

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48
Q

ruptured mitral valve chordae tenindae could elad to

A

acute left side heart failure

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49
Q

death of acute left side heart failure in

A

minutes to hours

50
Q

left or right side failure is very slow to cause what kind of edema

A

peripheral

51
Q

most peripheral edema is caused by fluid retntion of

A

kidneys

52
Q

atrial natriuretic peptide are produed where

A

heart - in atria

53
Q

brain type natruiretic peptide - where is it produced

A

ventricle of heart

54
Q

natruiretic means

A

trying to increase salt excretion

55
Q

natruiretic peptide trying to relieve

A

congestion during heart failure - they are trying to increase fluid and salt excretion

56
Q

whenever heart is stretched, like in failure, the stretchign causes the release of

A

ANP & BNP

57
Q

what does ANP stand for

A

atrial natruiretic peptide

58
Q

what does BNP stand for

A

brain type natruiretic peptide

59
Q

what do ANP and BNP do in kidney

A

decrease renin which decreases angiotesin II and aldosterone which decrease blood volume

60
Q

what natural thing prevent extreme congestive symptoms during cardiac failure

A

ANP & BNP

61
Q

ANP & BNP levels are used to determine

A

level of heart failure

62
Q

ANP & BNP in extreme heart failure are

A

overwhelmed, can’t decrease blood volume/edema enough

63
Q

what happens if no matter what body does it can’t reach the critical cardiac output level for normal fluid balance

A

decompensated heart failure happens

64
Q

decompensated heart failure leads to what kid of heart

A

severely damaged

65
Q

in decompensated heart failure, cannot maintain normal cardiac output despite

A

sympathetic stimulation
fluid retention
cardiac remodeling

66
Q

in decompensated heart failure what are kidneys doing

A

continuously saying heart presure is low, so keep keeping fluids
more and more fluid

67
Q

what happens to right atrial pressure in decompensated heart failure

A

kidney keeps reabsorbing more fluid, to put more back to heart, but heart can’t keep up so right atrial pressure keeps increasing

68
Q

progressive edema formation in

A

decompensated heart failure

69
Q

ultimately decompenstaed heart failure will result in

A

progressive edema everywhere - b/c kidneys are trying to keep up fluid retention but it is not enought o have normal CO

70
Q

what is main problem in decompensated heart fialure

A

heart not a good pump

71
Q

how do you try to help person in decompensated heart failure

A

try to make it a better pump

try to get rid of edema

72
Q

how do we get rid of edema with drugs

A

diahretics

73
Q

if yiu don’t decrease edema in decompensated heart failure what will happen to pt

A

drown in own fluids, edema will just continue

74
Q

what are the clinical consequences of decompensated heart failure

A

progressive edema, esp. the lungs
rales
dyspnea

75
Q

what is rales

A

clicking, rattling, crackling noises in lungs

76
Q

what is dyspnea

A

difficulty breathing

77
Q

why is there dyspnea in decompensated heart failure

A

so much fluid in lungs its harder foroxygen to diffuse from alveoli into blood

78
Q

lack of appropriate therapy in decompensated heart failure leads to

A

death

79
Q

what drugs do you give to pt in decompensated heart failrue to strengthen heart

A

cardiotonic drugs

80
Q

digitalis is a form of

A

cardiotonic drug

81
Q

biventricular heart failure

A

both ventricles failing

82
Q

unilateral heart failure

A

one side of heart is failing

83
Q

left side failure an lead to

A

right side failure

84
Q

left side heart failure means

A

something is going on just the left side of the heart

85
Q

left side heart failure causes what edema

A

pulmonary edema

86
Q

If right side of heart is pumping out 5 L/min and left is pumping out 4 L/min what happens

A

blood will back up in left atria and if left atria pressures increase then it also increases in lungs and get pulmonary edema

87
Q

anything that increases left atrial pressure will increase back into

A

lungs - pulmonary congestion, pulmonary edema, problems w/ breathing and posture changes

88
Q

if you’re in decompensated heart failure when do you need therapy to help

A

immediately or you’ll die

89
Q

if heart is overworked in heart failure pt can

A

die

90
Q

frequent cause of death in pts who have heart failure is often

A

acute pulmonary edema

91
Q

what often causes the acute pulmonary edema in pt w/ heart failure that kills them

A

temporary overload of heart - like old person cutting grass when they shouldn’t be

92
Q

increased workload on already wekaned heart, what happens

A

damning of blood in lungs, elevates pulmonary capillary pressure, fluid begins to transude into the lung tissues and alveoli, decreases oxygenation of blood further weakens heart - periphersal vasodilation, increases venous return which further increases work load on the heart

93
Q

review pg 21

A

21

94
Q

one of first lines of treatment for heart failure is

A

diuretics

95
Q

thiazide is a

A

diuretic

96
Q

natriuretic peptides is a

A

diuretic & vasodilator

97
Q

natriuretic peptides isn’t used often b/c

A

have to be infused, not activated orally

98
Q

why do you want to vasodilate in situation where there is heart failure

A

decrease afterload

they make it easier for heart to pump out blood

99
Q

ACE inhibitors are

A

vasodilators

100
Q

Angiotensin receptor blockers are

A

vasodilators

101
Q

digitalis is a

A

positivie ionotropoic agents - stimulate contractility in heart thatsfailing

102
Q

positive inotropic drugs do what

A

stimulate contractility

103
Q

beta agonist are examples of

A

cardiostimulatory

104
Q

cariostimulatory, what is another way to say this

A

inotropic drug

105
Q

what is problemw ith giving someone in heart failur ea beta agonist?

A

they are arthymogenic in high concentrations, so you are making heart more likely to have arrhythmia

106
Q

beta blockers can be used in heart failure as a

A

cardioinhibitory

107
Q

why can beta blockers be used in heart failure

A

blocking effects of sympathetic nerves so making it less arrhytmagenic
can protect the beta receptors

108
Q

in heart failure what happens to number of beta receptors

A

they fall

109
Q

calcium channel blocker are for dysfunction of

A

diastolic dysfunction

110
Q

calcium channel blockers ia what kind of drug

A

cardioinhibitory

111
Q

when you hear myoptahy it means

A

valves are ok, blood vessels are ok, something inherently wrong in the muscle itself that causes heart disaese

112
Q

myopathy means

A

pathology of the muscle

113
Q

three main cardiomyopathy

A

dilated
hypertrophic
restrictive (won’t talk about this)

114
Q

we won’t be directly tested on dilated and hypertrophic myopathy

A

:)

115
Q

do we know what causes dilated cardiomyopathy

A

no - but we konw somethings that can contribute to it like alcoholic and diabetes

116
Q

see my ntoes on cardiomyopathy to review and understand

A

in xodo

117
Q

person with dilated cardiomyopathy what is main problem?

A

systolic dysfunction - heart doesn’t pump strong enough

118
Q

pt with dilated cardiomyopathy what kind of drug?

A

to make the heart pump harder - positive inotropic agent like digitalis

119
Q

person with hypertropic cardiomyopathy how would you treat them

A

cardioinhibiotry drugs like beta blockers and calcium channel blockers

120
Q

what is wrong with heart in hypertropic cardiomyopathy

A

it doesnt relax right - problem is in diastolic

121
Q

what drugs for hypertropic cardiomyopathy

A

beta blockers

calcium channel blocker

122
Q

what are the cardiostimulatory drugs (there are 3)

A

digitalis
beta agonist
phosphodiesterase inhibitors

Physiology I Block 4 (13 decks)

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