Cardiac Muscle Dysfunction and Failure

Question 1

Causes and Types of Cardiac Muscle Dysfunction

Answer 1

Hypertension
CAD
Cardiac arrythmias
Rapid or slow arrhythmias can impair functioning of left and/or right ventricle
Renal Insufficiency
Cardiomyopathy
Heart Valve Abnormalities
Congenital/Acquired Heart Disease
pericardial effusion or myocarditis
Pulmonary embolism
Pulmonary hypertension
Spinal cord injury
Age-related changes

Question 2

Renal Insufficiency

Answer 2

Acute or chronic insufficiency produces fluid overload
Primary treatment is to decrease reabsorption of fluid from kidneys
Diuretic

Question 3

Cardiomyopathy

Answer 3

Contraction and relaxation of myocardial muscle fibers are impaired

Question 4

Primary causes of cardiomyopathy:

Answer 4

pathological process in heart muscle

Question 5

Secondary causes of cardiomyopathy:

Answer 5

result of systemic disease processes

Question 6

Types of cardiac myopathy:

Answer 6

dilated
hypertrophic
restrictive

Question 7

Dilated:

Answer 7

myocardial damage resulting from mitochondrial damage

Question 8

Causes of dilated myopathy:

Answer 8

long term alcohol abuse
pregnancy
cigarrete smoking
infections
systemic hyertension

Question 9

Hypertrophic:

Answer 9

rapid ventricular emptying

high ejection fraction

Question 10

Causes of hypertrophic myopathy:

Answer 10

genetic

malalignement of myocardial fibers

Question 11

Restrictive:

Answer 11

diastolic dysfunction with unimpaired contractile function

Question 12

Causes of restrictive myopathy:

Answer 12

myocardial fibrosis

ventricular hypertrophy

Question 13

Pericardial Effusion or Myocarditis

Answer 13

Injury to pericardium of heart may cause inflammation of pericardial sac (pericarditis)
Pericarditis leads to pericardial effusion

Question 14

Cardiac tamponade

Answer 14

elevated intracardiac pressures, limited ventricular diastolic filling, reduced SV

Question 15

Pulmonary Embolism

Answer 15

Resulting dysfunction is due to elevated pulmonary artery pressures that increase right ventricular work

Question 16

Pulmonary Hypertension

Answer 16

Defined by mean pulmonary artery pressure (mPAP)

Abnormal if >25 mm Hg or in patients with COPD if >20 mm Hg

Question 17

Congenital and Acquired Heart Disease

Answer 17

Result of altered embryonic development of normal structure or failure of structure to develop

Question 18

Two most common Congenital and Acquired Heart Disease:

Answer 18

congenital bicuspid aortic valve and leaflet abnormality associated with mitral valve

Question 19

Influences of stretch

Answer 19

Atrial contribution to ventricular filling
Total blood volume
Body position
Intrathoracic pressure
Intrapericardial pressure
Venous tone
Pumping action of skeletal muscle

Question 20

Stage 1 CHF:

Answer 20

redistrubution
cardiomegaly
broad vascular pedicle
PCWP 13-18 mmHg

Question 21

Stage 2 CHF:

Answer 21

interstitial edema
Kerley lines
PCWP 18-25 mmHg

Question 22

Stage 3 CHF

Answer 22

alveolar edema
PCWP greater than 35mmHg
consolidation
pleural effusion

Question 23

Alpha-adrenergic receptors

Answer 23

Alpha1 – marginally increases inotropic effect

Alpha2 – activates inhibitory G protein, which decreases inotropic effect

Question 24

Beta-adrenergic receptors

Answer 24

Beta2 stimulation promotes vasodilation of capillary bed and muscle relaxation of bronchial tracts
Beta1 stimulation increases heart rate and myocardial force of contraction

Question 25

Symptoms of CHF:

Answer 25

dyspnea
paroxysmal nocturnal dyspnea
orthopnea

Question 26

Dyspnea

Answer 26

breathlessness or air hunger

Question 27

Paroxysmal nocturnal dyspnea

Answer 27

unexplained episodes of shortness of breath occur in supine position

Question 28

Orthopnea

Answer 28

development of dyspnea in recumbent position

Question 29

Breathing patterns of CHF:

Answer 29

rapid respiratory rate at rest with quick and shallow breaths

Question 30

Heart sounds of CHF:

Answer 30

S3 indicates a noncompliant left ventricle and is associated with CHF
Rales

Question 31

Pulsus alternans

Answer 31

mechanical alteration of femoral or radial pulse