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ESA2 - Various > CVS Heart Failure > Flashcards

CVS Heart Failure Flashcards

1
Q

Normal cardiac output

A

5L/min

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2
Q

Normal stroke volume

A

75ml/beat

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3
Q

Normal LV end diastolic volume

A

150ml

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4
Q

Normal LV end systolic volume

A

75ml

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5
Q

Give some causes of heart failure.

A 
Any condition that reduces myocardial efficiency through damage or overload.
Ischaemic heart disease
Hypertension
Pregnancy
Congenital heart disease
Pericardial disease
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6
Q

What happens when the heart is overloaded.

A

Myocardium is overstretched and according to Starling’s law, contraction becomes less efficient at very high end diastolic volumes.

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7
Q

How is stroke volume affected in heart failure?

A

Increased end systolic volume due to reduced contractility

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8
Q

What falls in heart failure!

A

Inotropy - overload
Stroke volume
Spare capacity

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9
Q

What rises in heart failure

A

Heart rate
Hypertrophy
Ventricular volume - mechanical inefficiency

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10
Q

What does reduced CO cause?

A 
Arterial pressure falls
This activates Baroreceptors
Increased sympathetic activity
Vasoconstriction, increased TPR, increased after load
Increased intropy
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11
Q

Why does oedema occur?

A

Vasoconstriction and fluid retention results in increased capillary hydrostatic pressure so there is net outflow of fluid from the capillaries forming tissue fluid.

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12
Q

What is systolic dysfunction?

A

Failure of the heart to pump.
Strength of contraction is not sufficient.
Increased end systolic volume due to inadequate emptying.
Pressure transmitted to venous systems.

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13
Q

Where is led a found in right heart failure

A

Peripheral oedema as pressure is transmitted to systemic venous circulation

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14
Q

Where is oedema found on left heart failure? How does this affect the right heart.

A

Pulmonary oedema as pressure is transmitted to the pulmonary venous system.
As this is a low resistance system, the pressure is transmitted to the pulmonary arteries resulting in right ventricular hypertrophy.

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15
Q

What is systolic dysfunction caused by?

A

Thinning of myocardial wall
Mitral valve incompetence
Arrhythmias

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16
Q

What is diastolic dysfunction?

A

Failure of heart to relax.
Inadequate filling so inadequate stroke volume.
Reduced cardiac output.

17
Q

What structural heart changes occur in heart failure

A 
Loss of muscle
Increased collagen
Myocyte hypertrophy
SER dysfunction
Dilated heart is systolic dysfunction
Hypertrophied heart is diastolic dysfunction
18
Q

How does the starling curve change

A

Heart can no longer produce same amount of force for a given filling

Less CO for a given venous pressure

19
Q

Describe classes of heart failure

A

1 no symptoms
2 no limitation of physical activity. Fine at rest.
3 marked limitation of physical activity. Fine at rest.
4 inability to carry out physical activity without symptoms. Symptoms at rest

20
Q

What is congestive heart failure

A

Both ventricles affected

21
Q

Symptoms of left heart failure

A 
Pulmonary oedema
Tachycardia
Cardiomegaly
Fatigue
Extra heart sounds
Mitral regurgitation
22
Q

Symptoms signs of right heart failure

A 
Peripheral oedema
Raised JVP
Fatigue
Pitting oedema
Ascites
Hepatomegaly
23
Q

What causes right heart failure?

A

Lung disease
Pulmonary embolism or hypertension
Valve disease

24
Q

Describe the RAAS

A

Reduced kidney perfusion and stimulation of beta adrenergic receptors in the kidey causes renin release.
This converts angiotensin oven to angiotensin I.
ACE then converts angiotensin I to angiotensin II.
Angiotensin II acts on zona glomerulus to increase aldosterone which promotes reap take of sodium and water from the kidney tubules, which results in increased blood volume.
It also causes vasoconstriction.
Together these raise blood pressure, increaseing preload and after load.
ACE also fragments bradykinin.
Angiotensin can cause direct damage to heart myocytes

25
Q

Give 6 types of drugs for treating heartfailure

A 
ACE inhibitors
- vasodilation and reduced blood volume
Beta adrenoceptor antagonist
- reduced work of heart
Calcium channel blockers
- reduced contractility
Cardiac glycosides like digoxin
- inhibits sodium potassium ATPase
- increase CO and contractility by raising calcium inside
Diuretics
- reduce blood volume
Organic nitrates
- vasodilation
26
Q

How to treat heart failure

A

Correct underlying cause
Pharmalogically therapy
Complications or risk factors

27
Q

Define heart failure

A

Heart fails to maintain adequate circulation (cardiac output) for the needs of the body, despite adequate filling pressure.

28
Q

Two systems that contribute to heart failure

A

RAAS

SNS

29
Q

How does SNS contribute to heart failure?

A

Fall in blood pressure detected by Baroreceptors.
Signal to CVS I medulla oblongata
Vasoconstriction via alpha1
Increased BP increase preload increase after,lad
Positive inotropy and chronotropic
NA induced cardiac hypertrophy, myocyte apoptosis and necrosis via alpha receptors.

ESA2 - Various (21 decks)

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