Congestive heart failure

Question 1

low output failure

Answer 1

due to poor heart function

Question 2

high output failure

Answer 2

good heart function but metabolic demands are too high (ex. pregnancy and hypothyroidism)
leads to exhaustion and worsening heart failure

Question 3

pre-load

Answer 3

amont of blood in LV in cardiac filling

Question 4

after load

Answer 4

amount of force needed by LV to force blood throgh the body

Question 5

Congestion

Answer 5

back up of blood in vessels upstream of the heart

HTN and edema

Question 6

myocardial weakness

Answer 6

atheroscleorsis 
coronary artery thrombosis
myocarditis
cardiomyopathies 
coronary vasospasm

Question 7

restriction to pumping

Answer 7

Unable to cope with preload 
valve defects and incompetent valves 
internal blockage
malformation, thrombosis, t
pericarditis/pericardial effusion
dysrythmia

Question 8

increased afterload

Answer 8

systemic HTN, high vascular resistance= increased work load

pulmonary HTN- increase pressures with in pulmonary vessels

Question 9

high demands are due to

Answer 9

chronic anemia
thyrotoxicosis
pregnancy

Question 10

pulmonary HTN can predispose someone to

Answer 10

pnuemonia

Question 11

blood backing into right side of heart

Answer 11

right sided failure- leads to cardiomegaly, s/s of rs hf

capillaries increase their permeability- leads to edema

Question 12

why is there fluid in the lower extremities?

Answer 12

gravity

Question 13

systemic venous congestion leads to

Answer 13

hepatomegaly

splenomegaly- advanced CHF

Question 14

compensatory mechanism

Answer 14

normal= increased blood left behind= stretching of the fibers to increase force to increase SV (starlings law)
abnormal= dilation is excess and leads to thinning of the wall which= decrease of contractile force

Question 15

increased afterload

Answer 15

normal= increased afterload= increase of cardiac cells (increased strength and thickness)
abnormal= enlarged heart which decreases otpt

Question 16

increased sympathetic nervous stimulation

Answer 16

normal=
increase catecholamine to increase HR
vasoconstriction to maintain BP
abnormal=
increase hr= less time for LV to fill= added stress
increased BP= increased after load and pressure on heart

Question 17

stimulation of angiotensin system

Answer 17

normal= vasoconstriction and aldosterone release, increased na and water retention
abnormal= higher volume-> increased congestion and vasoconstriction- higher afterload and LV cardiomegaly

Question 18

ANF

Answer 18

atria in response to increase hr
suppresses renin and ADH this helps decrease plasma volume and increased afterload
unable to counter antagonistic effects on enhanced renin secretion in CHF

Question 19

TRX for CHF

Answer 19

diet- salt and fluid intake 
exercise rehab
valve replacement 
bypass 
angioplasty 
transplant

Question 20

chronotrophs

Answer 20

altering HR

Question 21

positive chronotroph=

Answer 21

increased HR

Question 22

negative chronotroph=

Answer 22

decreased HR

Question 23

B blockers

Answer 23

decrease HR and contractility, lowers BP, slows contractions, increase SV
care w astha and COPD becase B2 receptors also in lung

Question 24

introphs

Answer 24

\+ = increased contractility 
-= decreased contractility

Question 25

Digitalis

Answer 25

most widely used inotrope increases intracellular Ca for better contraction allows more forceful contraction at lower degree for myocardial distension Response= increased Hr and arterial BP less sympathetic response and decreased HR also known as a cardiac glycoside

Question 26

diuretics

Answer 26

decreased plasma volume works at renal tubular level prevents reabsorption of Na and water increase urinary output - decreased plasma volume- less work load problems- electrolyte loss lower BP which activates the renin angiotensin system

Question 27

anti arrhythmic drugs

Answer 27

regulate HR and rhythm provides more constant control of CO

Question 28

vasodilators

Answer 28

nitroglycerin relax smooth muscles which allows coronary arteries to provide more oxygen pooling of blood in extremities also= decreased demand on heart

Question 29

calcium channel blockers

Answer 29

inhibits ca into vascular smooth muscle, which reduces vasoconstriction

Question 30

ACE inhibitors

Answer 30

``` prevent angiotensin 1 to 2 angiotensin 2 is a potent vasodilator inhibits release of aldosterone and vasoconstriction helps decrease compensatory responses only drug shown to help with CHF ```