CVD: heart failure Flashcards
Heart failure affects more than … people
6.5 mil
Heart failure is the leading cause of hospitalization for people over …. years of age
65
What happens with heart failure?
Heart works less efficiently than normal: blood moves at slower rate, pressure in heart increases: heart cannot pump enough oxygen and nutrients to meet the body’s needs.
What happens to the walls when pressure in heart increases: heart cannot pump enough oxygen and nutrients to meet the body’s needs?
Walls get weak (stiff)
How do the kidneys respond to heart failure?
- Kidneys may respond by causing the body to retain fluid and salt. If fluid builds up in the
arms, legs, ankles, feet, lung or other organs, it is called congestive heart failure
Usually, heart failure starts at the … side, then leads to ….-sided heart failure
left, right
Symptoms heart failure?
- Congested lungs (shortness of breath, wheezing, dyspnea and orthopnea: when lying flat)
- Fluid & water retention
- Dizziness
- Rapid or irregular heartbeats
- Related to coronary artery disease (decreased blood flow heart muscles)
- Related to heart attack (coronary artery suddenly blocked)
- Related to cardiomyopathy (damage to the heart muscle due to e.g. infections / alcohol abuse)
Explain the difference between systolic and diastolic heart failure
Systolic: can’t pump hard enough
Diastolic: can’t fill enough
- explain the difference between left-sided and right-sided heart failure (HF)
left-sided heart failure: happens in left ventricle, right-sided in right ventricle. Term refers to primary problem affecting the heart. Because they both influence each other
A-sided heart failure is usually B, due to damage in the C
A left
B systolic
C myocardium
In both cases, blood ends up in the lungs -> fluid build-up
What is the ejection fraction?
the volume pumped out of the blood as a percentage of the total volume of blood.
Wat is a normal ejection fraction + systolic heart failure?
Normal = 50-70%. <40% = systolic heart failure
What is cardiac output?
amount of blood pumped by the heart per minute (volume blood/min)
What is the stroke volume?
Stroke volume = volume blood/beat
Diastolic heart failure: what happens with the ejetion fraction and total volume?
normal ejection fraction, low total volume. Abnormal filling, chamber does not get fully loaded.
What are causes of left-sided heart failure?
= ischemic heart disease
long-term hypertension,
(dilated, hypertrophic, restrictive )cardiomyopathy,
aortic stenosis,
How can long-term hypertension cause systolic heart failure?
High arterial pressure, harder to pump. Compensation: hypertrophy (increase/growth muscle cells) -> greater O2 demand, coronary gets squeezed by extra muscle. Weaker contraction, systolic failure
How can dilated cardiomyopathy cause
(systolic) heart failure?
Dilated cardiomyopathy = walls of the heart chambers dilate ->larger volumes of blood -> bigger contraction strength. However, over time muscle walls get thinner and weaker: systolic heart failure
How can 1. aortic stenosis (narrowing aortic valve opening) lead to 2. concentric hypertrophy, which can lead to left-sided diastolic heart failure?
Concentric hypertrophy: Concentric left ventricular hypertrophy is an abnormal increase in left ventricular myocardial mass caused by chronically increased workload on the heart
Heart muscle thickens towards the chamber: less room for filling.
How does Restrictive cardiomyopathy lead to diastolic left-sided heart failure?
= Muscles get stiffer and less compliant, left ventricle cannot stretch and fill: failure
In left-sided heart failure, blood gets to the…. In right-sided heart failure, blood gets to the ….
lungs, body
How does right-sided heart failure cause cirrhosis & liver failure or pitting oedema?
right-sided heart failure leads to excess blood to the body -> jugular vein (slagader in nek) = enlarged. Backs up to liver & spleen = hepato spend megaly -> cirrhosis & liver failure. Backs up to legs: pitting oedema
What are two causes for isolated right-sided cystolic or diastolic heart failure?
‘shunt’ (when blood from the left side (high pressure) flows to the right side (low pressure)
(systolic OR diastolic)
Cor pulmonale (chronic lung disease)
How does systolic + diastolic failure happen when you have a shunt?
Increase fluid volume right side, concentric hypertrophy (increase muscle), ischaemia -> systolic dysfunction.
At the same time: volume decreases bc of hypertrophy: diastolic dysfunction
How does cor pulmonale lead to right-sided heart failure?
Chronic lung disease ->Low oxygen levels -> pulmonary arteriole restriction -> raises blood pressure -> hypertrophy -> failure
- describe how the kidneys try to compensate for the decrease in blood that is pumped out during left-sided heart failure
= they activate the renin system, causing fluid retention which helps the heart. In long term, this can lead to leaks from blood vessels and can lead to fluid build-up in the lungs.
- describe how heart failure may lead to pulmonary oedema
= when the heart cannot pump enough blood to the body, it starts to back up into the lungs. This increases pressure in the pulmonary artery, resulting in fluid from the blood vessels into the interstitial space (lungs) causing pulmonary oedema
What are symptoms of a pulmonary oedema?
Symptoms: dyspnea (shortness breath), orthopnea (shortness breath when lying flat), crackles
- explain why patients with heart failure may have difficulty breathing
Because extra fluid can end up in the alveoli in the lungs, making O2 and CO2 diffusion difficult. Can sound like cracks when a person breathes
- describe the function of ACE-inhibitors and diuretics
ACE: dilate blood vessels
Diuretics: reduce fluid
= Medication for left-sided and right-sided heart failure
- explain how chronic lung disease may lead to right-sided heart failure
In response to low oxygen levels/hypoxia: pulmonary arterials constrict, increasing pulmonary blood pressure. Makes it harder for right side to pump, leads to failure
- identify whether patients have right- or left-sides HF based on their symptoms (e.g dyspnea (shortness of breath- left sided), ascites (buikvocht), oedema (swelling ankles/feet: right-sided)
ok
What is A major sign of heart failure?
when blood starts to back up into the lungs (= pulmonary oedema
