cardiovascular pathology

Question 1

what is inadequate in heart failure

Answer 1

cardiac output

Question 2

what is stroke volume dependent on and relate to heart failure

Answer 2

preload (inadequate venous return), afterload (excessibe resistance), contractility (inadequate)

Question 3

calculate stroke volume

Answer 3

end-diastolic volume - end-systolic volume

Question 4

define heart failure

Answer 4

syndrome caused by inability of heart to supply blood to tisses sufficient to meet metabolic needs, or achieved at expense of filling pressures, causing inadequate perfusion of organs

Question 5

what does heart failure lead to

Answer 5

congestion in lungs and legs

Question 6

compensation of heart failure to maintain cardiac output

Answer 6

tachycardia or more forceful contractions

Question 7

6 types of heart failure

Answer 7

left vs. right, chronic vs. acute, reduced ejection fraction vs. preserved ejection fraction

Question 8

features of left heart failure

Answer 8

dysfunction with left ventricle (ejection or filling) causing congestion into lungs (blood backs up into pulmonary veins, causing pulmonary hypertension and oedema)

Question 9

symptoms of left heart failure

Answer 9

“respiratory symptoms”: dyspnoea, coughing, wheezing, dizziness, cyanosis

Question 10

features of right heart failure

Answer 10

right ventricle dysfunction (ejection or filling) due to increased afterload of pulmonary circulation (pulmonary hypertension); often secondary to left heart failure; need more O2 but not supplied, leading to ischaemia

Question 11

features of chronic heart failure

Answer 11

slow onset due to infection, pulmonary embolism, myocardial infarction or surgery

Question 12

features of acute heart failure

Answer 12

rapid onset, similar to chronic except timing of onset and worsening is more severe

Question 13

features of heart failure with reduced ejection fraction

Answer 13

abnormal systolic function; impaired ventricle contraction despite increased heart rate, causing decreased cardiac output; caused by ventricular myocyte damage or valve abnormalities; decreases stroke volume with normal/increased end-diastolic volume; weaker ejection leads to higher diastolic pressures; blood can’t be expelled

Question 14

features of heart failure with preserved ejection fraction

Answer 14

abnormal diastolic function; normal ventricle contraction but increased stiffness, or impaired relaxation or filling; causes reduced end-diastolic volume and stoke volume; hypertrophy occurs inwards, so smaller space for blood; can’t gain blood

Question 15

incidence of heart failure

Answer 15

60-84 is majority of heart failure (rises at 60)

Question 16

6 causes of heart failure

Answer 16

valve disease, ischaemic heart disease, myocardial infarction, hypertension, dilated cardiomyopathy, hypertrophic cardiomyopathy

Question 17

clinical symptoms of heart failure

Answer 17

orthopnea (lying flat), exertional dyspnoea, fatigue, anorexia, weight loss

Question 18

clinical signs of heart failure

Answer 18

ascites, hepatomegaly, increased jugular venous pressure, reduced pulse volume, tachycardia

Question 19

clinical investigations of heart failure

Answer 19

x-ray, ECG, ambulatory ECG, exercise test, angiogram, BNP

Question 20

3 hallmarks of heart failure

Answer 20

increased jugular venous pressure (due to backing up after increased pressure in right side of heart), pitting oedema, ascites

Question 21

what is B-type natriuretic peptide (BNP) and what does it lead to

Answer 21

released from ventricular myocytes in response to stretch, reducing ECF and pressure, so used as clinical marker of heart failure

Question 22

how does B-type natriuretic peptide (BNP) reduce ECF and pressure

Answer 22

causes microvessel vasodilation, reduced aldosterone secretion, reduced Na+ reabsorption and inhibited renin secretion

Question 23

lifestyle treatment for heart failure

Answer 23

weight loss, exercise, stop smoking, reduce alcohol

Question 24

3 1st line pharmalogical treatment for heart failure

Answer 24

ACE inhibitors to reduce afterload; beta blockers to reduce HR; diuretics to cause fluid loss to reduce BP

Question 25

2 2nd line pharmalogical treatment for heart failure

Answer 25

ivabradine to cause vasodilation; valsartan to stop aldosterone production

Question 26

4 non-pharmalogical treatments for heart failure

Answer 26

haemofiltration/dialysis, ventricular assist device, coronary bypass artery graft, transplantation