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ESA 2 > CVS 11.1 - Heart Failure > Flashcards

CVS 11.1 - Heart Failure Flashcards

1
Q

What is heart failure?

A

A state in which the heart fails to maintain an adequate circulation for the needs of the body despite an adequate filling pressure

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2
Q

How does ischaemic heart disease lead to heart failure?

A

u

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3
Q

How does hypertension lead to heart failure?

A
  • Causes LV hypertrophy which then dilates
  • Chronic increased afterload = decreased ventricular compliance
  • Increases oxygen demand of the myocardium
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4
Q

How does dilated cardiomyopathy lead to heart failure?

A
  • LV becomes large and weakened
  • ↓ pumping ability of hypertrophic part
  • ↓ function
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5
Q

How does valvular heart disease lead to heart failure?

A
  • Stenosis of blood in the atria = Doesn’t drain properly
  • ↑ stretch of the myocardium
  • Stretches enough to damage electrical conducting system
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6
Q

How does pericardial disease lead to heart failure?

A
  • ↑ fluid between heart and pericardium
  • ↑ intrapericardial pressure
  • Causes ↑ SV so ↑ CO
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7
Q

Give an example of high output heart failure and describe how it can lead to heart failure

A
  • Anaemia
  • ↓ haemoglobin = ↑ work load of heart to compensate for ↓ O2
  • Puts extra pressure on the mitral valve
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8
Q

How does heart failure progress?

A
  • Class 1 = no symptoms, physical activity isn’t limited
  • Class 2 = physical activity slightly limited resulting in symptoms (not at rest)
  • Class 3 = Limited physical activity, less than normal resulting in symptoms (none at rest)
  • Class 4 = Can’t exercise with symptoms, ↑ with activity and are present at rest
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9
Q

What is the value for cardiac output?

A

5 litres/minute

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10
Q

What is the value for stroke volume?

A

75ml/beat

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11
Q

What is the value of LV eSV?

A

~75ml

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12
Q

What is the value of LV eDV?

A

~150ml

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13
Q

What is ejection fraction?

A

The percentage of blood ejected from each ventricle per contraction (50%)

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14
Q

What is starling’s law? How does this relate to heart failure

A
  • The force developed in a muscle fibre is dependent on the degree to which the fibre is stretched i.e. volume of blood
  • HF = ↓ force for the same amount of volume
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15
Q

What is systolic dysfunction? How is it caused?

A
  • Left ventricular ejection fraction becomes lower than 40% due impaired ventricular contraction
  • Myocardial wall becomes thinner due to fibrosis/necrosis (↑ type 1-3 collagen) and matrix proteinases
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16
Q

What happens to cardiac output and LV capacity as a result of systolic dysfunction?

A
  • LV capacity increases

- LV Cardiac Output decreases

17
Q

What changes can occur to cause systolic dysfunction?

A
  • Dilatation of the left ventricle
  • Pulls cusps of the mitral valve apart = dysfunction
  • ↑ risk of cardiac dysrrhythmias
18
Q

What are the structural changes involved in heart failure?

A
  • Globalised remodelling (dilatation) leading to localised thinning. Acute infarction = ↓ skeletal muscle blood flow so ↓ skeletal muscle mass
  • Diastolic heart failure due to hypertrophy of left ventricle -> becomes smaller so can hold less volume and becomes stiff
19
Q

What are the cellular changes involved in heart failure?

A
  • Myocyte hypertrophy
  • Irregular Ca2+ regulation
  • ↑ Na+, angiotensin 2 and cytokines
  • Release of troponin C
20
Q

How does stimulation of the sympathetic nervous system lead to an increased cardiac output?

A
  • Beta-1 activation in heart = +ve chronotropic effect (↑HR)
  • Beta-1 activation in heart = +ve inotropic effect (↑ contractility)
  • Alpha-1 activation in vascular smooth muscle = vasoconstriction of arteries so ↑ workload (↑ preload and afterload)
21
Q

How can sympathetic stimulation become detrimental?

A
  • Leads to downregulation of beta adrenoceptors

- Noradrenaline promotes formation of fibrosis and hypertrophy and promotes ↑RAAS

22
Q

What is the function of angiotensin 2?

A
  • Promotes LV hypertrophy and myocyte dysfunction
  • Causes vasoconstriction
  • Causes aldosteron release (Na+ and H2O retention in the kidneys = ↑BV)
23
Q

How does bradykinin contribute to the cardiovascular system?

A
  • Promotes natriuresis (Na+ excretion in the urine)
  • Promotes vasodilation
  • Stimulates prostaglandin production
  • Stimulates NO production
24
Q

What are natiuretic hormones?

A
  • Polypeptide hormones (endocrine and paracrine) secreted by cardiac myocytes in response to ↑ stretch for powerful vasodilation
  • Maintain blood pressure and extracellular blood volume
25
Q

What do natiuretic hormones promote?

A
  • Inhibition of aldosterone and renin
  • Natiuresis
  • Constriction of afferent arterioles
  • Dilation of efferent arterioles

ESA 2 (63 decks)

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