Cardiology deck 2

Question 1

What creates the myocardial stretch?

Answer 1

end-diastolic volume and the muscle fibers

The muscle fibers reach a certain length at a certain speed, and these factors will determine the force of contraction. The principle is similar to when you stretch a rubber band. The more you stretch a rubber band the more forceful the snap when released.

Question 2

What is the limit to the Frank-Starling law

Answer 2

beyond a certain point the muscle fibers will lose contractile ability. Overstretching over time will eventually cause the rubber band to lose elasticity; when stretched and released, it will barely snap

Question 3

Laplace’s law

Answer 3

explain factors influencing afterload, which is a pressure that is opposite to preload. In Laplace’s law, wall stress (i.e., tension) is due to pressure in the ventricle and the radius (i.e., diameter), which is inversely related to wall thickness. In other words, the wall stress is influenced by pressure, diameter, and wall thickness.

Question 4

In Laplace’s law….Wall stress affects metabolic demands, and the higher the wall stress the __________________

Answer 4

greater the metabolic demand.

Question 5

When the ventricle wall thickness increases……

Answer 5

the opposite happens, and like a bodybuilder’s big muscle, the heart does not have to contract as hard.

Question 6

increasing radius or pressure ______ wall stress

Answer 6

increases

Question 7

increasing wall thickness _______ wall stress

Answer 7

decreases

Question 8

baroreceptors sense drops in blood pressure, causing the heart rate to ______, vessels to _____, and the contractility to _______ to maintain perfusion.

Answer 8

Increase, constrict, increase

Question 9

baroreceptors sense increase in blood pressure, causing the heart rate to ______, vessels to _____, and the contractility to _______ to maintain perfusion.

Answer 9

decrease, vasodilate, decrease

Question 10

How does aging affect baroreceptors

Answer 10

Aging causes changes to these receptors that make them less effective and leads to a slower response.

When an elderly person changes position from sitting to standing, the receptors do not respond as quickly (i.e., blood pressure does not rise) and hypotensive signs such as dizziness or blurred vision occur. This response is termed postural hypotension.

Question 11

ADH, also known as vasopressin,

Answer 11

increases water reabsorption in the kidney, which increases blood volume. Additionally, ADH is a vasoconstrictor, which increases SVR.

Question 12

When is the renin–angiotensin–aldosterone system (RAAS) activated?

Answer 12

renal blood flow is decreased,

Question 13

How does the renin–angiotensin–aldosterone system (RAAS) work?

Answer 13

When renal blood flow decreases ->renin is released from the kidneys ->activates angiotensin I ->converts to angiotensin II (a vasoconstrictor) through the actions of angiotensin-converting enzyme in the lungs ->aldosterone secretion is stimulated ->Aldosterone (from the adrenal cortex) increases the reabsorption of Na+ and Cl- in the kidneys ->Na+ attracts water, which, like ADH, increases blood volume

Question 14

what does the renin–angiotensin–aldosterone system (RAAS) do in a hypotensive state?

Answer 14

this mechanism raises blood pressure and maintains the blood supply to vital organs

Question 15

renin–angiotensin–aldosterone system (RAAS) do in a hypertensive state?

Answer 15

inappropriately activated because of reduced blood flow (vasoconstriction) to the kidneys, further contributing to the hypertension.

Question 16

natriuretic hormones (e.g., atrial natriuretic peptide) cause _____ of Na+, Cl-, and water.

Answer 16

loss

Question 17

what is the lymphatic system

Answer 17

an extensive network of vessels and glands that returns excess fluid (about 3 liters per day) in body tissue to the circulatory system and works with the immune system

Question 18

What does Interstitial fluid provide for the cells?

Answer 18

Interstitial fluid surrounds cells and provides a medium through which nutrients, gases, and wastes can diffuse between the capillaries and the cells.

Question 19

What is included in the lymphatic system?

Answer 19

lymph nodes, the spleen, the thymus, the bone marrow, and tonsils

Question 20

What is the primary function of the lymphatic system

Answer 20

immune response

Question 21

What happens as the lymph passes through the nodes,

Answer 21

he fibers filter out bacteria, viruses, and cellular debris. Numerous macrophages line the channels to phagocytize microorganisms and other material.

Question 22

What is the rate at which lymph is produced

Answer 22

the rate at which it is removed.

Question 23

What are some examples of lymph produced exceeds the capacity of the system.

Answer 23

burns can cause extensive damage to capillaries, causing them to leak fluid into the tissues. This flooding results in excessive fluid in the tissue, or edema. Fluid can also leak into the tissues as a result of lymphatic vessels becoming occluded, often because of infection.

Question 24

Valvular disorders cause

Answer 24

disruption of normal blood flow through the heart.

Question 25

How is Valvular heart disease diagnosed?

Answer 25

a history and physical examination and evaluation with an echocardiogram. valuate causes or consequences of the valve disease and can include heart catheterization, chest X-rays, EKG, or MRI.

Question 26

Valvular heart disease management

Answer 26

geared toward the actual or potential consequences of the valve disease such as heart failure, cardiomyopathy, and symptomatology.

Question 27

What are the Two types of alterations r/t valvular heart disease

Answer 27

stenosis and regurgitation.

Question 28

__________ and __________valve disease are more common due to the higher pressures and workload on the left side of the heart.

Answer 28

Aortic and mitral

Question 29

Atresia

Answer 29

lack of the valve opening

Question 30

What happens to the workload of the heart when you have valvular atresia?

Answer 30

Pressures in the overfilled chambers increase to pump against the resistance of the stenosed valve. Because the heart (specifically the chamber) is working harder, hypertrophy of the chamber develops. Hypertrophy and increased workload escalate the heart’s oxygen demands, but the decreased cardiac output resulting from the stenosis makes it difficult to meet these increased demands. The cardiac output ultimately decreases, leading to clinical deterioration. Other heart disorders such as cardiomyopathy and heart failure can develop

Question 31

one of the most common valvular diseases in the United States

Answer 31

Aortic stenosis

Question 32

Regurgitation

Answer 32

also called insufficiency or incompetence, occurs when the valve leaflets do not completely close, so blood continuously leaks. Additionally, heart valves normally allow blood to flow in one direction; incompetent valves, however, allow blood to flow in both directions. This regurgitation of blood increases the amount of blood that must be pumped and, in turn, increases the cardiac workload. The increased workload contributes to hypertrophy developing in the affected chambers. Additionally, the increased blood volume in the heart causes the chambers to dilate to accommodate the larger volume.

Question 33

What can cause Valvular disorders

Answer 33

congenital defects, infections, endocarditis, rheumatic fever, hypertension, myocardial infarction, cardiomyopathy, and heart failure.

Question 34

What valvular problems are associated with Marfan syndrome

Answer 34

aortic and mitral valve can become regurgitant.

Question 35

Mitral Valve Prolapse

Answer 35

common valve disorder and is the most common cause of mitral regurgitation causes the valve leaflets to billow into the left ventricle or flail and prolapse into the left atrium during systole

Question 36

Treatment for Aortic stenosis or regurgitation

Answer 36

can be medically managed, but most patients will ultimately need valve repair or replacement

Question 37

Treatment for Mitral stenosis and regurgitation

Answer 37

can be treated medically first, but there are circumstances when repair or replacement is necessary urgently (e.g., acute mitral regurgitation caused by an MI or chest trauma).

Question 38

valvotomy

Answer 38

technique involves percutaneously introducing a catheter with a balloon that goes through the stenotic valve and is inflated to clear the calcifications

Question 39

Cardiomyopathies

Answer 39

disease of the heart muscle that can lead to several types of structural (e.g., hypertrophy) and functional (e.g., systolic/diastolic dysfunction) changes. The structural and functional changes in cardiomyopathy can cause heart failure.

Question 40

cardiomyopathies are classified into three groups

Answer 40

dilated cardiomyopathy (DCM), hypertrophic cardiomyopathy (HCM), and restrictive cardiomyopathy

Question 41

Cardiomyopathy Classification MOGE(S) stands for:

Answer 41

M morphofunctional phenotype O organ involvement G genetic or family inheritance pattern E etiologic description S functional status.

Question 42

Key heart changes with Dilated Cardiomyopathy

Answer 42

Dilated hypertrophied ventricles but normal wall thickness | systolic dysfunction

Question 43

Key heart changes with hypertrophic cardiomyopathy (HCM)

Answer 43

Hypertrophied thick walled ventricle (usually interventricular septum) Diastolic dysfunction

Question 44

Key heart changes with Restrictive Cardiomyopathy

Answer 44

Rigid ventricle walls but normal wall thickness | Diastolic dysfunction

Question 45

Complications of Cardiomyopathy

Answer 45

Atrial fibrillation Ventricular Tachyarrhythmias heart failure

Question 46

What is heart failure

Answer 46

condition in which the heart has a problem with ventricular filling or ejection, which then leads to a decreased cardiac output and inadequate perfusion

Question 47

most common risk factors of heart failure

Answer 47

hypertension, metabolic syndrome, diabetes mellitus, and atherosclerotic disease

Question 48

One of the top causes of death from cardiovascular disease

Answer 48

Heart failure with a 50% death rate usually occurring within 5 years of diagnosis

Question 49

Heart failure incidence increases dramatically after the age of

Answer 49

65

Question 50

two preferred categorizations for heart failure (for left sided heart disease)

Answer 50

heart failure with reduced EF (HFrEF) for systolic dysfunction and heart failure with preserved EF (HFpEF) for diastolic dysfunction

Question 51

Right-sided heart failure is a result of

Answer 51

right ventricle impairment and is most often a consequence of left-sided heart failure

Question 52

cor pulmonale

Answer 52

Right ventricle impairment can also occur with pulmonary diseases that cause pulmonary hypertension The term cor pulmonale is generally not used when the right-side dysfunction is due to left-sided heart failure.

Question 53

The most common causes of either type of heart failure are

Answer 53

coronary artery disease and hypertension Other common risks more frequently seen in patients with HFpEF are diabetes, obesity, coronary artery disease, and dyslipidemia.

Question 54

compensatory mechanisms are activated in times of decreased cardiac output

Answer 54

catecholamine release (epinephrine and norepinephrine) ->stimulates SNS->vasoconstriction ->, increases heart rate, contractility->antidiuretic hormone secretion With SNS stimulation and decreasing cardiac output, renal perfusion decreases, which activates RAAS. Renin, angiotensin, and aldosterone are released, which leads to fluid retention, vasoconstriction, cell hypertrophy, cell death, and myocardial fibrosis. These compensatory mechanisms increase cardiac output in the beginning, but they eventually lead to excessive preload and afterload. The compensatory mechanisms eventually become inadequate to meet the body’s metabolic needs, and excessive myocardial oxygen demand and an increased preload result in decreased contractility and decompensation

Question 55

Left ventricle (LV) remodeling

Answer 55

changes in the mass, volume, and shape of the heart and occurs in response to decompensation and injury.

Question 56

Left sided heart failure basic effects

Answer 56

decreased cardiac output | pulmonary congestion

Question 57

R sided heart failure basic effects

Answer 57

decreased cardiac output | systemic congestion

Question 58

key manifestations of L sided heart failure

Answer 58

pulmonary congestion, dyspnea, activity intolerance

Question 59

Key manifestations of R sided heart failure

Answer 59

edema and weight gain

Question 60

As L sided heart failure worsens....

Answer 60

symptoms start to occur with less activity and even at rest. Orthopnea (shortness of breath when supine) is a late symptom and occurs due to fluid shifts from the peripheral to the central circulation. The fluid shifts occur while in a supine position and results in increased pulmonary pressure. Increased pressure around bronchial vessels and the increased airway resistance causes paroxysmal nocturnal dyspnea. Paroxysmal nocturnal dyspnea symptoms include coughing and wheezing that wake patients up at night. If blood continues to accumulate, pulmonary edema and right-sided heart failure will develop.

Question 61

Right-sided heart failure is a result of

Answer 61

ineffective right ventricular contraction

Question 62

When R sided heart failure progresses

Answer 62

blood does not move appropriately out of the right ventricle. Blood backs up first in the right atrium, and then the peripheral circulation, causing increased pressures in the peripheral capillary bed. The patient begins to gain weight, as fluid is not excreted by the kidneys. Tissue becomes edematous, as pressures in the capillaries push fluid out of the circulatory system. Most patients have a combination of left- and right-sided heart failure and therefore manifestations will reflect a combination of both. TABLE 4-3 Clinical Manifestations of Left- and Right-Sided Heart Failure

Question 63

Stage A heart failure

Answer 63

At risk

Question 64

Stage B heart Failure

Answer 64

structural disease but no symptoms yet.

Question 65

Stage C and D heart failure

Answer 65

have clinical heart failure

Question 66

New York Heart Association classes (I–IV)

Answer 66

used to evaluate functional capacity symptoms of heart failure with activity. Patients can go back and forth with New York Heart Association classes (i.e., III–II or I–II).

Question 67

heart failure Diagnosis, staging, and class determination are based on

Answer 67

a history and physical and diagnostic tests. echocardiogram -function and causes. A brain natriuretic peptide (BNP) or N-terminal pro brain natriuretic peptide A chest X-ray may reveal signs of fluid retention such as pleural effusions and vascular congestion. Thoracic ultrasonography can be used to evaluate for acute cardiopulmonary respiratory failure, pleural effusion, and pneumothorax. A 12-lead EKG may expose causes and coexisting disorders that occur with heart failure such as atrial fibrillation and myocardial infarction, but no finding is specific to heart failure. Other routine labs include urinalysis, CBC, a chemistry profile with calcium and magnesium, lipid panel, liver function, and thyroid-stimulating hormone evaluation. Other additional blood work may be ordered if there is suspicion of certain causes of the heart failure (e.g., HIV, hemochromatosis). With patients who are hospitalized, additional tests may include a troponin test, arterial blood gases, cardiac catheterization, and myocardial biopsy depending on causes and status.

Question 68

Lab that shows a hormone released by the ventricles in response to overstretching

Answer 68

brain natriuretic peptide (BNP) or N-terminal pro brain natriuretic peptide

Question 69

lifestyle modifications for heart failure

Answer 69

weight reduction, tobacco cessation, reduced salt consumption, fluid restriction, and exercise

Question 70

angiotensin-converting enzyme (ACE) inhibitors

Answer 70

stop the renin–angiotensin–aldosterone cycle

Question 71

pharm for HFrEF

Answer 71

ACE inhibitors angiotensin receptor blockers (ARBs), or an angiotensin receptor neprilysin inhibitors (ARNIs) ARNIs, are a combination of an ARB with an inhibitor of the enzyme neprilysin. Neprilysin causes the breakdown of beneficial natriuretic peptides, which help to maintain fluid homeostasis

Question 72

All patients with heart failure should be on either an

Answer 72

ACE, ARB, or ARNI and a selective beta-1–adrenergic blocking agent or an alpha-1, beta-1, beta-2 receptor blocker (to slow the heart rate and thereby increase diastolic filling).

Question 73

type of diuretic for patients in fluid volume overload

Answer 73

preferably loop diuretics, which act at the loop of Henle to prevent sodium or chloride reabsorption

Question 74

HFpEF

Answer 74

Heart failure with preserved ejection fraction