Cardiac Patho pt.2 (Exam 3) Flashcards
Heart Failure
Left versus right sided
Systolic Versus Diastolic
Preserved Versus Reduced
Cardiomyopathy
Disease that affect the myocardium (heart muscle)
LEAD TO HEART FAILURE AND HEART FAILURE SYMPTOMS
What causes Cardiomyopathy
Idiopathic
Can be related to ischemia - HTN - Inherited disorders - infections - toxins - myocarditis - auto-immune condition
3 Types of Cardiomyopathy
Dilated cardiomyopathy
Hypertrophic cardiomyopathy
Restrictive cardiomyopathy
Dilated Cardiomyopathy
Ventricles become dialted
Ischemic Problems - Alc - Drugs -Valve Disease - Post Partum - Infection
Hypertrophic Cardiomyopathy
Related to HTN. Ventricles become enlarged
Restrictive Cardiomyopathy
Usually RS
Hardening. Muscle become rigid
Heart Failure: Definition
Chronic progressive condition in which the heart muscle is unable to pump enough blood to meet the body’s needs for blood and oxygen
Heart can not keep up with its workload
What factors determine CO
Heart rate
Stroke volume
Three factors involving stroke volume
Preload
Afterload
Myocardial contractility
Preload
Fluid volume
Amount of volume in LV before it systole (it pumps)
Afterload
The pressure the hearts have to squeeze against as it contracts
Directly Related to BP
High blood pressure = Higher afterload
Myocardial contractility
Is the pump working like it should
Is the heart pumping effectively
Heart failure results in
Decreased Cardiac output, decreased myocardial contractility, increased preload, increased afterload
Pathological changes that occur in Heart Failure (4)
Volume overload (to much volume on board)
Impaired ventricular filling - occurs during diastole
Weakened Ventricular Muscle
Decreased ventricular Contractile function - systole
Etiology: Major causes of HF
Repeated ischemic episodes (CAD)
Myocardial infarction + papillary muscle rupture
Chronic HTN
COPD (Pulmonary pressure alters and RVF)
Dysrhythmias (decrease CO and perfusion to coronary arteries)
Valve disorders; mitral insufficiency, aortic stenosis
Pulmonary Embolism (RVF)
RF’s for HF
Hypertension and DM are the greatest risk factors
MI’s within 6 months
Black and African Americans
Age
Family hx and genetics
Obesity
Ischemic Heart disease
Lifestyle factors
STABLE ANGINA IS NOT
COPD
Severe Anemia
Congenital heart defects
Viruses: Myocarditis (Inlfammation)
Alcohol abuse/Drug Abuse
Kidney Conditions
Heart Failure Classifications
Right Sided
Left Sided
Left Sided Heart failure blood
Backs up into the pulmonary circulations
Right sided heart failure blood
Backs up into systemic circulation
Left Sided HF: Etiology
Congestion in LEFT chambers
LV increases in size (LVH)
Backflow into pulmonary veins
Congestion into the LUNGS
Left Sided HF: S/S
Cough-crackles-wheezes
Frothy sputum may be blood tinged
Paroxysmal nocturnal dyspnea (PND) (Wake up and can not breath)
Orthopnea (Can’t breath laying flat)
What is the condition in which you wake up and can not breath
paroxysmal. nocturnal dyspnea
associated with LS heart failure
What is the condition in which you can not breath while laying flat
Orthopnea
Right Sided HF: Eitiology
Due to COPD (cor pulmonale)
Congestion in RIGHT chambers
RV increases in size (RVH)
Backflow into vena cava, decreased to the lungs
Congestion in jugular viens, liver, lower extremities
Right sided HF: S/S
JVD
Dependent Edema
Weight Gain
ascites
fatigue
Hepatosplenomegaly (enlarged spleen and liver)
Loss of appietite
Most common cause of left HF
HTN
Most common causes of right HF
COPD
Ejection Fraction
Percentage of blood pumped out of the LV with each squeeze.
Normal = 55-65%
Heart Failure: Reduced Ejection Fractions
(HFrEF) (Systolic HF)
Determined by patients ejection fraction — < 40%
HFrEF caused by
Impaired contractile function, increased afterload, cardiomyopathy, and mechanical problems
Left ventricle loses ability generate pressure to eject blood enough percentage of blood
Weakened muscle cannot generate stroke volume and the lowers cardiac output
LV fails, blood backs up, causes fluid backup and accumulation
Heart Failure with Preserved Ejection Fraction
(HpEF) (Diastolic HF)
Inability of the ventricles to relax and fill during diastole
HFpEF caused by
Inability of the ventricles to relax and fill
Most commonly HTN. Females are at greater risk
LV is stiff and non compliant leading to high filling pressure and decreased stroke volume
Ejection is normal or only moderately decreased (40-49%)
Ejection Fractions HFpEF
Ejection fraction is preserved at 40-49%
Ejection Fractions HFrEF
Ejection fraction is reduced to <40%
Ventricular Remodeling
A weakened heart muscles starts to secretes molecular substances like
Angiotensin II, aldosterone, endothelin, TNF-alpha, catecholamines, insulin-like growth factor, and growth hormone
These substances provoke genetic changes, apoptosis and hypertrophy of cardiac myocytes, as well as collagen deposits and myocardial fibrosis
Molecules causes changes and lead to ENLARGEMENT AND DILATION of LV and causes worsening HF
S3 Gallop
Low pitched sound heard after S2 (Aortic and Pulmonic Closing)
During rapid filling of the ventricles
In adults older tahn 40 years an S3 is abnormal and indicative of heart failure
HFpEF: Common in
Older age females
HFrEF: Common in
Younger age males
