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Patho > chapter 20- HF > Flashcards

chapter 20- HF Flashcards

1
Q

Heart Failure

A

complex syndrome of the heart that results from functional or structural impairment of ventricular filling or ejection of blood into the circulation.
*Assoc. with either a reduced or preserved L Ventricular EF

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2
Q

Compensatory Ability

A
  • how your body pumps just sitting around vs running a marathon
  • CO^: Exercise
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3
Q

Cardiac Reserve

A

how much the heart compensates to increase output during exercise

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4
Q

Myocardial Contractility

A

(inotrophy)

  • the contractile performance of the heart (actin and myosin)
  • as contractility ^, CO ^
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5
Q

Preload

Afterload

A

P- Amt. of blood in ventricles at the end of diastole

A- measure of force that was required to eject the blood from the ventricles

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6
Q

Ejection Fraction

A

the % of total amount of blood that entered ventricle that is actually moved out. (normal: 60%)

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7
Q

Most common causes of HF

A

coronary artery disease, hypertension, dilated cardiomyopathy, valvular heart disease

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8
Q

Efficiency of the heart is determined by:

A

the volume of blood that ejects each minute

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9
Q

Frank Starling Mechanism

A

*activation of neurohumoral influences: SNS and RAAS,
the naturetic peptides, vasoactive substances, hypertrophy and remodeling of heart

  • Firs minutes- hours: SNS keeps heart pumping, RAAS is released to vasoconstrict and retain water
  • Weeks: myocardial hypertrophy and remodeling for long-term adaptation to hemodynamic overload.
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10
Q

Heart Failure with reduced EF stimulates:

A
  • RAAS pathway
  • body retains water and sodium in kidney which ^ vascular volume and venous return to heart
  • causes PULMONARY CONGESTION
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11
Q

Natriuretic Peptides (NP)

A
  • naturally released in body response to overstretching of atria or ventricles (Heart Failure)
  • inhibits SNS, RAAS, and ADH
  • ANP & BNP levels are ^ in HF patients
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12
Q

A Nat Peptide

B Nat Peptide

A

A- released from ATRIAL cells in response to stretch, pressure, or fluid overload
B- secreted by VENTRICLES in response to ^ ventricular pressure or fluid overload

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13
Q

Both types of NP are released in response to:

A

^ chamber stretch and pressure
* promotes rapid and transient natriuretesis and diuretics through an increase in glomerular filtration rate and inhibit tubular sodium and water reabsorption

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14
Q

NP’s inhibit the natural response to heart failure: ___ and ___

A

SNS and RAAS (antidiuretic hormone and vasopressin)

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15
Q

the activation of SNS releases: ___

A

Catecholamines

-Epinephrine and Norepinephine to ^ HR and ^ CO

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16
Q

Enodthelins

A

Vasoconstrictors released from endothelium
Induce myocyte hypertrophy and fibrosis
bolster effects of hypoxic kidneys
-counteract BNP and ANP to encourage water and salt absorption in kidney

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17
Q

myocardial hypertropohy and remodling

A

cells change size to keep up with the demand

- last step in heart compensation to HF

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18
Q

Concentric Hypertrophy

Eccentric Hypertrophy

A

Concentric: caused by pressure overload
*myocytes get wider, heart walls get thicker

Eccentric: caused by volume overload
*myocytes get longer, heart walls get thinner

19
Q

Types of Heart Failure:

A
  1. Systolic (HRrEF)
  2. Diastolic (HRpEF)
  3. Left Sided
  4. Right sided
20
Q

Systolic (HRrEF) Failure:

A
  • not pumping out enough during systole (reduced EF) despite a normal BP (EF <40%)
  • Causes: volume overload, pressure overload, contractile function impairment

*Effects: Eccentric Hypertrophy, Increased blood volume: Pulmonary Congestion

21
Q

Symptoms of Systolic HF

A

dyspnea, fatigue, JVD, peripheral edema, orthopnea, Paroxysmal Nocturnal Dyspnea

22
Q

Diastolic (HRpEF)

A
  • preserved EF- reduced/abnormal filling of ventricle
  • EF (>50%) but ventricle doesn’t fill all the way to EF goes down
  • causes of diastolic HF: pericardial effusion, constrictive pericarditis, myocardial hypertrophy (^ wall thickness), AGING, HYPERTENSION
23
Q

Systolic failure vs Diastolic failure

A

S: impaired ability to eject blood at a rate commensurate with the metabolic needs of the tissue

D: resistant to filling of one or both ventricles leading to symptoms of congestion

24
Q

Diastolic HF can be aggravated by ____

A

tachycardia (wont let the ventricles fill all the way)

25
Q

Symptoms of Diastolic HF

A

pulmonary congestion, decrease in lung compliance, ^ in workload and breathing: dyspnea.

26
Q

____ determines how much time there is for ventricular filling.

A

Heart Rate

27
Q

Left-Sided Heart Failure

A

Diastolic: LV doesn’t accept enough blood from lungs
Systolic: LV doesn’t pump enough blood to body

28
Q

in Left Sided HF, the blood backs up from__ to:

A

LV –> pulmonary veins –> Lungs –> pulmonary arteries –> right atria/ventricles –> body

29
Q

Left-sided HF causes:

A
  • pulmonary edema, dyspnea

* Paroxysmal Nocturnal Edema- trouble breathing when sleeping due to ^ fluid in the lungs

30
Q

Left-sided HF is attributed to:

A
  1. Hypertension
  2. Acute MI
  3. Valvular Defects
31
Q

Right-Sided Heart Failure

A

Diastolic: RV doesn’t accept enough blood from body
Systolic: RV doesn’t pump enough blood to lungs

32
Q

In Right Sided HF, the blood backs up from ___ to:

A

RV –> Inferior/Superior Vena Cava –> LV —> lungs

33
Q

Right-Sided HF causes:

A
  1. Left sided heart failure- L ventricular filling
  2. isolated R side failure- not common, occurs in ppl with lung disease or pulmonary hypertension, tricuspid valve disease, R ventricular infarction, or cardiomyopathy
34
Q

Cor Pulmonale

A

Right Ventricular HF that occurs in response to chronic pulmonary disease

35
Q

Right-Sided HF symptoms:

A
  1. ^ in RV diastolic and end-diastolic: EDEMA
  2. back up of blood in Inferior and Superior Vena Cava:
    Hepatomegaly & Splenomegaly
  3. Congestion of GI tract: anorexia and discomfort
  4. JVD- can be seen sitting down or standing up
36
Q

Symptoms of HF for both sides: (5)

A
  1. Edema
  2. Dyspnea- (Cheyne-stokes) respiration
  3. Cachexia- malnutrition & tissue wasting that occurs at end stage HF
  4. Cyanosis- blue coloring of skin and mucous membranes
    5 Arrhythmia & sudden cardiac death- A fib
37
Q

Diagnosis of HF

A
  • History
  • Physical Exa
  • Lab testing ( ^BNP, ^ electrolytes
  • Imaging- electrocardiogram
38
Q

Acute HF treatment

Chronic HF treatment

A

A- stop the underlying cause

C- relieve symptoms, reduce further damage/reverse damage thats happened. Long term plan

39
Q

Treatment for all HF

A
  • Exercise
  • Drugs (diuretics, B-adrenergic inhibitors, ACE inhibitors)
  • Oxygen (CPAP force air into cells/lungs)
  • Invasive Methods: LVAD Left Ventricular Assist Device
40
Q

Increased electrolytes in HF signifies:

A
  • impaired renal function
  • higher than normal electrolyte levels means kidneys are reabsorbing water and sodium
  • HF
41
Q

cardiac output is the ___ each minute

A

blood pumped

42
Q

in shock, one of the best indicators of blood flow to vital organs is:

A

urine output

43
Q

A common symptom of ischemia associated with gastrointestinal redistribution of blood flow is:

A

gastric bleeding

44
Q

which type of shock might intravenous therapy be distributed for?

A

Distributive shock

Patho (18 decks)

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