Cardiac failure Flashcards

1
Q

What is heart failure

A

Failure of the heart as a pump to meet the circulatory needs

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2
Q

After a myocardial infarction, what types would the heart failure be

A

Chronic or acute

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3
Q

What is heart disease precipitated by

A

Pregnancy
ANaemia
Hyper and hypothyroidism
Fluid retaining drugs like glucocorticoids and NSAIDs

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4
Q

How does hyperthyroidism lead to heart disease

A

Can over stimulate the heart which would lead to heart failure

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5
Q

How does hypothyroidism

A

Can under stimulate the heart which would lead to heart failure

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6
Q

What does ischaemic heart disease affect

A

Impaired muscle function ie preload, after load, and muscle contractility

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7
Q

What is ischeamic heart disease

A

Coronary heart disease

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8
Q

How is hypertension a risk for chronic heart failure

A
  • For the increase in after load, you get left ventricular hypertrophy
  • This means the heart is less efficient at generating force
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9
Q

To compensate for circulatory failure, what gets activated in the body

A
  • Sympathetic nervous system
  • Renin-angiotensin-aldosterone system
  • ADH
  • Atrial Natriuretic Peptide (ANP)
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10
Q

How does the sympathetic nervous system compensate for circulatory failure

A

Acts on beta adrenoceptors which keeps the heart going

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11
Q

How does ADH compensate for circulatory failure

A

Conserves fluid which would lead to fluid overload

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12
Q

How does ANP compensate for circulatory failure

A

Released by failing atria which would lead to the excretion of sodium

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13
Q

What do the macula densa detect

A

Low sodium and low blood pressure and volume

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14
Q

What do the macula densa release

A

Renin

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15
Q

How does the renin-angiotensin system make heart failure worse

A
  • Renin chops up angiotensinogen to make angiotensin 1. This is chopped up to angiotensin 2 by angiotensin converting converting enzyme
  • From angiotensin 2, this leads to vasoconstriction and augments the sympathetic nervous system
  • It also acts on adrenal glands to release aldosterone which retains sodium and causes potassium loss

=ALl of these leads to increased effort needed by heart which is bad because there is higher pressure and more fluid

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16
Q

What does increased vasoconstriction lead to

A

Increased resistance which leads to impaired renal function and so further renin angiotensin cycle

17
Q

When does left-sided hypertension usually occur

A

Often after hypertension

18
Q

What does poor output from the left hand side lead to

A

Increase in left atrial and pulmonary venous pressure with pulmonary oedema

19
Q

What does right sided failure often lead to

A

Lung disease

Pulmonary valvular stenosis

20
Q

How is biventricular failure caused

A

Left ventricular failure leads to pulmonary congestion which may lead to right ventricular pressure

-Or ischaemic heart disease

21
Q

Symptom of pulmonary oedema

A

Shortness of breath (drowning sensation)

22
Q

What causes paxosymal nocturnal dysponoea

A

When a patient is lying down, it promotes venous return and so in those with oedema, the blood rushes back to heart and lungs

23
Q

What is peripheral oedema associated with

A

Right hand side failure

24
Q

What is the value of ejection fraction which is consistent with heart failure

25
Symptoms of right ventricular failure
- Raised venous pressure - Increased jugular vein pressure - Enlarged liver - Peripheral oedema
26
How to primarily diagnose heart failure
Echocardiogram which sees if the ejection fraction is less than 45%
27
How is the BNP used to diagnose heart failure
When ventricles go into failure, they release BNP. Therefore if they are elevated it indicates heart failure
28
How does heart failure lead to atrial fibrillation
-LEft ventricle/valve failure leads to increased pressure in the left atria which leads to distension which leads to atrial fibrillation
29
Goals of treatment for heart failure
- Reduce cardiac workload - Increase cardiac output - Counteract maladaptation - Prolng quality of life because the prognosis of heart failure is poor
30
What does pulmonary oedema look like in a chest x-ray
Fluffy
31
What is an indication of heart failure In a chest X-ray
Enlargement of the heart
32
Symptoms od left ventricular failure
- Awakening at night with shortness of breath. - Shortness of breath during exercise or when lying flat. - Chronic coughing or wheezing. - Difficulty concentrating and Fatigue. - Fluid retention causing swelling, or oedema, in the ankles, legs and/or feet. - Lack of appetite and nausea.