Cardiac Failure Flashcards
one of the major causes of cardiac failure is
ischemic heart disease
what does heart failure mean
any heart condition that reduces ability of heart to pump enough blood to meet body’s needs
congestive heart failure
regular heart failure that also has congestion
any valvular defect can lead to
heart failure
just because you have coronary artery disease, or mitral regurtigation, or aortic stenosis, etc. doesn’t mean you have
heart failure
presence of cardiac disease does not mean your heart is
in failure
when cardiac disease progress to where heart cannot meet needs of the body, it becomes
failure
disease can lead to failure but
the disease itself doesn’t meant you are in failure
primary cardiac disease are the
myopathies - like dilated cardiomyopathy
primary cardiac disease are disease of
the muscle themselves
valvular defect, there isn’t anything wrong with the muscle -
the valve problem is what causes the problem with the muscle
what are the acute effects of moderate cardiac failure
reduced CO
damming of blood in the veins
why does atrial pressure increase after cardiac failure
blood is returning but the heart can’t pump enough out - so you get damming of veins
why do you get damming of veins b/c of moderate cardiac failure
heart can’t pum pout enough
right after heart is damaged what isfrst compensatory mechanism you see
sympathetic nervous system
describe sympathetic compensation after cardiac failure
Baroreceptor reflex, chemoreceptor reflex, CNS ischemic response(if really bad).
Increase rate and force (functional muscle)
Increase in venous return
what happens to cardiac function curve after compensation
it is going to move back up b/c of the compensation (see pg 4)
how much the cardiac function curve moves up after cardiac failure depends on
how much damage was caused
what two things happen in chronic stage of failure
retention of fluid by kidney
cardiac remodeling
why is there retention of fluid by kidney
cardiac remodeling in chronic stage of failure
to reach the critical cardiac output level for normal fluid balance
what happens in kidney during hcronic stage failure to increase fluid retention
decreased glomerular filtration
actiation of renin-angiotensin system
increased aldosterone secretion
moderate fluid retention in cardiac failure is beneficial - why?
increase in venous return to help compensate for dimnished pumping ability of heart
body is trying to reabsorb fluids to stretch heart to
make it better pump and bring CO to normal level
if fluid retention gets to point where CO is normal, then
the body won’t retain more fluid
too much fluid retention in response to cardiac fauilre is
bad - fine line b/w how much is god and how much is bad
if there is too mjuch fluid in severe cardiac failure what could happen
overstretch the heart - this is BAD
b/c of the too much fluid in severe cardiac failure what could happen in lungs
filtration of fluid into the lungs, causing pulmonary edema and because of that deoxygenation of blood
if you have too much fluid in severe cardiac filuare what coul dhappen inrest of body
edema
collateral circulation will being to penetrate the peripheral portions of the infarcted area of the
heart
what happens to the muscle part of undamged portion of heart after MI
hypertrophy
what happens to infarcted area of heart after MI
collateral blood supply penetrates the peripheral portions of infarcted heart
what do you see in compensated heart failure
normal cardiac output at rest
higher than normal right atrial pressure
in compensated heart failure there is normal CO but
it takes a lot more stretching of the heart to do it and a lot of fluid retention
in compensated heart failure you see reduced
cardiac reserve
a person in compensated heart failur eis fine at rest, but
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
cardiac disease moving into failure you will always see what immediate effect
increase sympathetic nervous stimulation
wwhat is the intermediate phase of compensated heart failure
reabsorption of fluid by kidneys
reabsorption of fluid by kidneys - what three things do we see happen in kidney
- Decreased glomerular filtration
- Increased renin angiotensin system
- Increased aldosterone secretion
what is the final thing you will always see in heart failure
remodeling of the heart
what two things can you see in remodeling of th eheart
Collateral blood supply
Hypertrophy
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
what it needs to be at to hav normal CO
left side heart failure will often lead to
right side failure
right side failure leads to
congestion of peripheral tissues
what will you see in right side heart failure
liver congestion
fluid in abdomen (ascites)
GI congestion
what congenital problems can lead to right side heart failure
pulmonary hypertension & tetrology of fallot
acute left side heart failure can occur how quickly
minutes
acute left side heart failure causes rapid
congestion of lungs and pulmonary edema
ruptured mitral valve chordae tenindae could elad to
acute left side heart failure
death of acute left side heart failure in
minutes to hours
left or right side failure is very slow to cause what kind of edema
peripheral
most peripheral edema is caused by fluid retntion of
kidneys
atrial natriuretic peptide are produed where
heart - in atria
brain type natruiretic peptide - where is it produced
ventricle of heart
natruiretic means
trying to increase salt excretion
natruiretic peptide trying to relieve
congestion during heart failure - they are trying to increase fluid and salt excretion
whenever heart is stretched, like in failure, the stretchign causes the release of
ANP & BNP
what does ANP stand for
atrial natruiretic peptide
what does BNP stand for
brain type natruiretic peptide
what do ANP and BNP do in kidney
decrease renin which decreases angiotesin II and aldosterone which decrease blood volume
what natural thing prevent extreme congestive symptoms during cardiac failure
ANP & BNP
ANP & BNP levels are used to determine
level of heart failure
ANP & BNP in extreme heart failure are
overwhelmed, can’t decrease blood volume/edema enough
what happens if no matter what body does it can’t reach the critical cardiac output level for normal fluid balance
decompensated heart failure happens
decompensated heart failure leads to what kid of heart
severely damaged
in decompensated heart failure, cannot maintain normal cardiac output despite
sympathetic stimulation
fluid retention
cardiac remodeling
in decompensated heart failure what are kidneys doing
continuously saying heart presure is low, so keep keeping fluids
more and more fluid
what happens to right atrial pressure in decompensated heart failure
kidney keeps reabsorbing more fluid, to put more back to heart, but heart can’t keep up so right atrial pressure keeps increasing
progressive edema formation in
decompensated heart failure
ultimately decompenstaed heart failure will result in
progressive edema everywhere - b/c kidneys are trying to keep up fluid retention but it is not enought o have normal CO
what is main problem in decompensated heart fialure
heart not a good pump
how do you try to help person in decompensated heart failure
try to make it a better pump
try to get rid of edema
how do we get rid of edema with drugs
diahretics
if yiu don’t decrease edema in decompensated heart failure what will happen to pt
drown in own fluids, edema will just continue
what are the clinical consequences of decompensated heart failure
progressive edema, esp. the lungs
rales
dyspnea
what is rales
clicking, rattling, crackling noises in lungs
what is dyspnea
difficulty breathing
why is there dyspnea in decompensated heart failure
so much fluid in lungs its harder foroxygen to diffuse from alveoli into blood
lack of appropriate therapy in decompensated heart failure leads to
death
what drugs do you give to pt in decompensated heart failrue to strengthen heart
cardiotonic drugs
digitalis is a form of
cardiotonic drug
biventricular heart failure
both ventricles failing
unilateral heart failure
one side of heart is failing
left side failure an lead to
right side failure
left side heart failure means
something is going on just the left side of the heart
left side heart failure causes what edema
pulmonary edema
If right side of heart is pumping out 5 L/min and left is pumping out 4 L/min what happens
blood will back up in left atria and if left atria pressures increase then it also increases in lungs and get pulmonary edema
anything that increases left atrial pressure will increase back into
lungs - pulmonary congestion, pulmonary edema, problems w/ breathing and posture changes
if you’re in decompensated heart failure when do you need therapy to help
immediately or you’ll die
if heart is overworked in heart failure pt can
die
frequent cause of death in pts who have heart failure is often
acute pulmonary edema
what often causes the acute pulmonary edema in pt w/ heart failure that kills them
temporary overload of heart - like old person cutting grass when they shouldn’t be
increased workload on already wekaned heart, what happens
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
review pg 21
21
one of first lines of treatment for heart failure is
diuretics
thiazide is a
diuretic
natriuretic peptides is a
diuretic & vasodilator
natriuretic peptides isn’t used often b/c
have to be infused, not activated orally
why do you want to vasodilate in situation where there is heart failure
decrease afterload
they make it easier for heart to pump out blood
ACE inhibitors are
vasodilators
Angiotensin receptor blockers are
vasodilators
digitalis is a
positivie ionotropoic agents - stimulate contractility in heart thatsfailing
positive inotropic drugs do what
stimulate contractility
beta agonist are examples of
cardiostimulatory
cariostimulatory, what is another way to say this
inotropic drug
what is problemw ith giving someone in heart failur ea beta agonist?
they are arthymogenic in high concentrations, so you are making heart more likely to have arrhythmia
beta blockers can be used in heart failure as a
cardioinhibitory
why can beta blockers be used in heart failure
blocking effects of sympathetic nerves so making it less arrhytmagenic
can protect the beta receptors
in heart failure what happens to number of beta receptors
they fall
calcium channel blocker are for dysfunction of
diastolic dysfunction
calcium channel blockers ia what kind of drug
cardioinhibitory
when you hear myoptahy it means
valves are ok, blood vessels are ok, something inherently wrong in the muscle itself that causes heart disaese
myopathy means
pathology of the muscle
three main cardiomyopathy
dilated
hypertrophic
restrictive (won’t talk about this)
we won’t be directly tested on dilated and hypertrophic myopathy
:)
do we know what causes dilated cardiomyopathy
no - but we konw somethings that can contribute to it like alcoholic and diabetes
see my ntoes on cardiomyopathy to review and understand
in xodo
person with dilated cardiomyopathy what is main problem?
systolic dysfunction - heart doesn’t pump strong enough
pt with dilated cardiomyopathy what kind of drug?
to make the heart pump harder - positive inotropic agent like digitalis
person with hypertropic cardiomyopathy how would you treat them
cardioinhibiotry drugs like beta blockers and calcium channel blockers
what is wrong with heart in hypertropic cardiomyopathy
it doesnt relax right - problem is in diastolic
what drugs for hypertropic cardiomyopathy
beta blockers
calcium channel blocker
what are the cardiostimulatory drugs (there are 3)
digitalis
beta agonist
phosphodiesterase inhibitors
