Cardiac Muscle Dysfunction: Heart Failure Part 1 Flashcards

1
Q

heart failure

  • definition
  • cardinal manifestations
  • “heart failure” preferred over _____
A

complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood
manifestations
-dyspnea (need to consider DDx)
-fatigue
-fluid retention (variable)
heart failure preferred over “congestive heart failure”

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2
Q

heart failure

-clinical manifestations

A

marked decrease in exercise tolerance
decline in functional status
decrease in QOL

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3
Q

heart failure facts

  • how common
  • how much money
  • prognosis
A

how common
-affects 5.7 million Americans
-550,000 new cases are diagnoses annually
how much money
-single most costly CV illness in US
-total treatment costs estimated at $30.7 billion annually
-compared to $132 minnion for lung cancer research (400,000 Americans)
prognosis
-one in 9 deaths list HF as contributing cause
-about 50% those diagnosed with HF die within 5 years

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4
Q

etiologies of HF

A

intrinsic cardiac disease
myocardial damage (post-MI) or s/p chemotherapy, radiation, drugs
excess work load
other

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5
Q

intrinsic cardiac disease specifics

A

coronary heart disease (CHD)
cardiomyopathy (CM)
valve disease

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6
Q

what can cause an excess work load on the heart

A

HTN
aortic stenosis
pulmonary HTN

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7
Q

other etiologies of HF

A

family history
chronic alcohol abuse
anabolic steroid - long term use

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8
Q

cardiomyopathy

-what happens?

A

heart muscle loses ability to pump effectively

heart becomes larger as it tries to compensate for its weakened condition

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9
Q

pathophysiology of HF

A

abnormal stroke volume due to

  • impaired contractility
  • increased afterload
  • impaired ventricular filling
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10
Q

measurements of heart function

A
ejection fraction (LVEF)
-normal 55-75%
cardiac output
-normal 4-8 L/min
LVEDV or LVEDP
echocardiogram
exercise stress test
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11
Q

preload

  • definition
  • relation to HF
A

defines as “tension on muscle fibers at EDV”
can be abnormal in individuals with HF
heart can’t contract fully - get increased volume in ventricles

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12
Q

inotropic drugs

-what do they do

A

assist heart contractility

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13
Q

what happens to LVEDP and SV with a failing heart?

  • add a diuretic
  • add a vasodilator
  • add a beta-agonist
A

LVEDP increases, SV decreases
diuretic
-decreases pressure the most, no effect on SV
vasodilator
-decreases pressure moderately, increases SV the most
beta-agonist
-decreases pressure the least, increases SV the most

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14
Q

how do the following affect factors that contribute to BF?

  • diuretic
  • vasodilator
  • beta-agonist
A
diuretic
-reduces preload
vasodilator
-afterload
beta-agonist
-increases inotropy
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15
Q

afterload and HF

  • what is it
  • afterload increases with
A

resistance encountered by LV when it tries to eject blood (systole)
afterload increased with increase in arterial vasomotor tone

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16
Q

increased afterload causes

A

increases myocardial oxygen consumption
-pumping against resistance
decreased stroke volume
in normal heart, increased afterload has little effect on SV
in HF< small increases in afterload can have big effects on SV

17
Q

3 main types of cardiomyopathy

A

dilated
restrictive
hypertrophic

18
Q

dilated CM

-what happens

A

muscle fibers stretch and heart chamber enlarges

-non-optimal length tension relationship

19
Q

restrictive CM

-what happens

A

ventricle walls stiffen and lose flexibility

20
Q

hypertrophic CM

A

growth and arrangement of muscle fibers are abnormal
heart walls thicken, especially in LV
preload increased

21
Q

HF -systolic dysfunction

A

loss of contractility
dilated ventricle
increases LVEDV
leads to decreased EF

22
Q

HF - diastolic dysfunction

A

impaired filling due to hypertrophy or decreased filling

results from HTN or aortic stenosis

23
Q

sign of cardiac dysfunction

A

decreased ejection fraction

24
Q

dilated CM effect on

  • LVEDP
  • force of muscle contraction
  • systolic vs. diastolic
A

increase LVEDP
decrease force of muscle contraction
systolic

25
Q

hypertrophic cardiomyopathy effect on

  • LVEDP
  • force of muscle contraction
  • systolic vs diastolic
A

decrease LVEDP
increase or decrease (more advanced) force of muscle contraction
diastolic