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pathophysiology 3801 > congestive heart failure > Flashcards

congestive heart failure Flashcards

1
Q

what are the two intrinsic mechanisms of heart rate regulation?

A

-frank-starling law
-right atria dilation

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2
Q

the force or tension developed in a muscle fibre depends on the extent to which the fibre is stretched

A

frank-starling law

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3
Q

what hormones does the sympathetic nervous system release in terms of heart rate regulation

A

epinephrine and norepinephrine

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4
Q

what hormones does the sympathetic nervous system release in terms of heart rate regulation

A

acetylcholine

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5
Q

______ is a complex syndrome in which abnormal heart function results in clinical signs and symptoms of low cardiac output and/or pulmonary or systemic congestion (e.g. pulmonary edema)

A

heart failure

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6
Q

_____ is the amount of blood leaving the left ventricle

A

cardiac output

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7
Q

______ is the pressure in the right side of the heart as blood returns to the heart

A

cardiac preload

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8
Q

_______ is the pressure the heart must pump against within the arterial system to eject blood (peripheral vascular resistance)

A

cardiac afterload

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9
Q

what’s the average cardiac output for an adult

A

5L/min

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10
Q

what are the determinants of cardiac output

A

heart rate and stroke volume

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11
Q

what is equation for ejection fraction

A

stroke volume/end diastolic volume

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12
Q

left ventricular failure categories
pathology: anemia, hyperthyroidism, valve defects, hypertension, asymmetric ventricular hypertrophy

A

inappropriate overloads placed on the heart

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13
Q

left ventricular failure categories
pathology: mitral stenosis, pericardial disease

A

restrictive filling of the heart

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14
Q

left ventricular failure categories
pathology: MI, coronary artery disease

A

myocyte loss

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15
Q

left ventricular failure categories
pathology: poisons, viral and bacterial infections

A

decreased myocyte contractility

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16
Q

right ventricular failure categories
pathology: congenital (shunts, obstructions), idiopathic pulmonary hypertension

A

precapillary obstruction

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17
Q

right ventricular failure categories
pathology: hypoxia induced vasoconstriction, pulmonary embolism and COPD

A

cor pulmonale (disease of heart caused by lungs)

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18
Q

right ventricular failure categories
pathology: right ventricular infarction

A

primary right ventricular failure

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19
Q

right ventricular failure categories
pathology: left cardiac heart failure

A

congestive heart failure

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20
Q

what 4 categories cause left ventricular failure

A
  1. myocyte loss
  2. decreased myocyte contractility
  3. inappropriate overloads placed on the heart
  4. restrictive filling of the heart
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21
Q

what 4 categories cause right ventricular failure

A
  1. precapillary obstruction
  2. congestive heart failure
  3. primary right ventricular failure
  4. cor pulmoanle
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22
Q

what is the pathophysiology of left ventricular heart failure at the hemodynamic level?

A

systolic and diastolic dysfunction

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23
Q

what is the pathophysiology of left ventricular heart failure of the neural-humoral level

A
  • activation of compensatory mechanisms
  • cytokines
  • endotelin and vasopressin
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24
Q

what is the pathophysiology of left ventricular heart failure at the cellular level

A

hypertrophy and remodelling

25
Q

______ is usually the result of an MI. evidenced by low ejection fraction and reduced ionotrpohy (contractility) during ventricular systole. impaired contractility is caused by loss of cardiac muscle cells, b-receptor down regulation and reduced ATP production

A

systolic dysfunction

26
Q

______ is usually caused by hypertension and ischemic heart disease. more likely to develop in the elderly, in women and in those without a history of MI. decreased myocardial relaxation that renders the ventricle non complaint decreasing filling. low CO with normal ejection fraction

A

diastolic dysfunction

27
Q

what is the first mechanism to occur when there is low cardiac output therefore the heart is failing

A

sympathetic nervous system is activated

28
Q

favourable effects for this neural-humoral change: increased heart rate, increased contractility, vasoconstriction = increased venous return and increased filling

A

increased sympathetic activity

29
Q

favourable effects for this neural-humoral change: salt and water retention = increased venous return

A

increase in renin-angiotensin-aldosterone and
increase in vasopressin

30
Q

favourable effects for this neural-humoral change: may have roles in myocyte hypertrophy and left ventricular remodelling

A

increase in interleukins (IL-1) and TNF alpha

31
Q

favourable effects for this neural humoral change: vasoconstriction = increase venous return

A

increase in endothelin

32
Q

unfavourable effects for this neural humoral change: arteriolar constriction = after load = increased workload = increase in o2 consumption

A

increase in sympathetic activity

33
Q

unfavourable effects for this neural humoral change: vasoconstriction = increased afterload

A

increase in renin-angiotensin-aldosterone and
increase in vasopressin

34
Q

unfavourable effects for this neural-humoral change: apoptosis

A

increase in interleukins (IL-1) and TNF alpha

35
Q

unfavourable effects for this neural humoral change: increased afterload

A

increase in endothelin

36
Q

what changes may happen at the cellular level during heart failure?

A
  • changes in Ca handling: need for Ca for contraction of the heart
  • changes in a adrenergic receptors: sensitivity/# of alpha and beta receptors can change
  • changes in contractile apparatus: due to large ineffective myocytes
  • changes in myocyte structure: left ventricular remodelling
37
Q

________ is the process by which ventricular size, shape and function are regulated by mechanical, neuro-humoral and genetic factors. related to myocyte hypertrophy, apoptosis, and fibrosis; the end result of body attempt to compensate

A

left ventricular remodelling

38
Q

angiotensin II, TNF alpha and norepinephrine cause _______ related to left ventricular remodelling.

A

myocyte hypertrophy

39
Q

TNF alpha and hypertrophy cause _______ related to left ventricular remodelling

A

apoptosis

40
Q

fibroblast activation (endothelin) and collangenases (myocyte slippage) cause _______ related to left ventricular remodelling

A

fibrosis

41
Q

are these backward effects associated with left ventricular failure or right ventricular failure
- dyspnea
- orothopnea
- basilar crackles
- cough
- cyanosis
- paroxysmal nocturnal dyspnea (sensation of sob awakens pt often after 1-2 hours of sleep, usually relieved in the upright position)

A

left ventricular failure

42
Q

are these the forward effects associated with left ventricular failure or right ventricular failure
- fatigue
- restlessness
- increased heart rate
- faint pulses
- confusion
-anxiety
-oliguria (production of abnormally small amounts of urine)

A

both LVF and RVF

43
Q

are these the backward effects of left ventricular failure or right ventricular failure
- hepatomegaly (enlarged liver)
- ascites (fluid collects in abdomen)
- splenomegaly (enlarged spleen)
- anorexia
- jugular vein distention (bulging of major veins in neck)

A

right ventricular failure

44
Q

what are some other signs and symptoms of CHF?

A
  • chest pain
  • S3 gallop (S3 sound unique to heart failure)
    -nocturia (urinating at night)
  • anascara (swelling of the whole body)
  • hepatojuguylar reflex (press on liver to see jugular veins enlarge)
  • abdominal pain
45
Q

know the different classifications of heart failure based on the New York heart association

A

class I - no limitations; ordinary physical activity does not cause fatigue, sob, palpitations or angina
class II- mild limitations; comfortable at rest. ordinary physical activity (carry heavy packages) may result in fatigue, sob, palpitations and angina
class III- marked limitation; comfortable at rest. less than ordinary physical activity (getting dressed) leads to symptoms
class iv - severe limitation; symptoms of heart failure or angina are present at rest and worsened with activity

46
Q

how is CHF diagnosed

A
  • past medical history
  • physical examination
  • lab and radiology findings
47
Q

__________ is another valuable diagnostic test for CHF. looks at CBC, liver biochemistry, cardiac enzymes, brain natriuretic peptide (BNP) and thyroid function

A

blood tests

48
Q

______ is another valuable diagnostic test for CHF. used to establish the presence of systolic and/or diastolic impairment of the left or right ventricle

A

echocardiography

49
Q

______ + ______ are released from the atria and ventricles in response to increased wall stress. patients with HFrEF (heart failure with reduced ejection fraction) tend to have higher levels than pts with HFpEF (heart failure with preserved ejection fraction), whereas levels may be falsely low in obesity. valuable in differentiating between cardiac and pulmonary causes of sob

A

BNP and NT-pro-BNP

50
Q

list some examples of Framingham’s major criteria for diagnosing CHF

A
  • paroxysmal nocturnal dyspnea
  • neck vein distention
  • rales
  • cardiomegaly
  • acute pulmonary edema
  • increased venous pressure
  • positive hepatojugular reflex
51
Q

list some examples of Framingham’s minor criteria for diagnosing CHF

A
  • extremity edema
  • night cough
  • dyspnea on exertion
  • hepatomegaly
  • pleural effusion
  • tachycardia
  • weight loss
52
Q

regarding Framingham’s criteria, what needs two be established for a clinical diagnosis of CHF

A

need at least one major and two minor criteria

53
Q

what is the pharmacological treatment for CHF

A

BAADDA
B- beta blocker
A- ACE inhibitor
A- ARB
D- diuretic
D- digoxin
A- aldactone

54
Q

this med is used if volume overloaded; decreases preload, BP and edema

A

diuretic

55
Q

this med iOS used if still have symptoms and low K+. also decreases Na retention

A

aldactone (spironolactone)

56
Q

this drug decreases HR and enhances contractility

A

digoxin

57
Q

these two drugs are vasodilators and counteracts RAAS

A

ACE inhibitor and ARB’s

58
Q

this med is used if stable and no fluid overall; may feel weak and tired for a few days, then stable. reduces HR and NP through SNS to decrease oxygen consumption of the heart muscle

A

beta blockers

59
Q

what are some non-pharm recommendations for CHF

A
  • 1.5-2L of fluids a day
  • exercise
  • sodium restriction
  • close supervision and follow up
  • flu and pneumonia vaccines

pathophysiology 3801 (8 decks)

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