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ANP > CVS Pathophysiology > Flashcards

CVS Pathophysiology Flashcards

1
Q

What is cardiac failure?

A
  • Heart cannot provide sufficient cardiac output for the metabolic needs of the body
  • Aka Congestive Heart Failure (CHF) or Cardiac Heart Failure (CCF)
  • Symptoms: increase venous pressure
    (heart fails -> backlog of blood (congestion) -> increase venous pressure)
  • Diseases lead to CHF, not a diseases of its own
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2
Q

What are the common causes/etiology of CHF?

A
  • Inappropriate work load
    (volume or pressure overload)
  • Loss of muscle = cardiac muscle cells die
  • Restricted/poor filling
    (preload determines stroke volume. decrease blood in = decrease blood out = CHF
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3
Q

What causes volume overload?

A
  • Regurgitant valve

- High output status

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4
Q

How does regurgitant valve cause volume overload?

A

Eg. aortic valve regurgitation

  • Aortic valve becomes leaky/cannot close properly = aortic regurgitation
  • Blood coming in from left atrium –> fills the left ventricle –> aortic valve leaky –> blood comes back into left ventricle –> causes heart to dilate and pump harder –> to accommodate to additional leaky volume –> chamber size increases –> muscle thickness –> hypertrophy
  • Over a long period of time –> increase in chamber size and hypertrophy –> heart cannot last indefinitely as heart cannot handle the increase volume workload –> cardiac failure
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5
Q

How does pressure overload cause volume overload?

A

eg. hypertension (high bp)
- High BP –> causes heart to pump harder to push blood out –> causes heart chamber to thicken –> to compensate the high pressure –> after some time, heart give up –> cardiac failure

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6
Q

How does loss of muscle cause volume overload?

A

eg. Post Myocardial Infarction
- area of MI = area where blood supply cut off
- cells are dead in that area –> only surrounding cells can be use for contraction –> decrease pumping efficiency –> not enough blood coming out –> cardiac failure

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7
Q

How does restricted filling cause volume overload?

A

eg. pericardial diseases
- pericardium diseases –> heart is still good–> but pericardium thickens and shrinks –> compresses the heart chambers –> heart chambers become small –> blood cannot come in from SVC and IVC –> decrease blood in, decrease blood out –> cardiac failure

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8
Q

What are some examples of etiology of cardiac failure?

A
  • Volume overload
    > regurgitant valve
    > high output status
  • Pressure overload
    > systemic hypertension
    > outflow obstruction
Loss of muscles
> Post MI
> Chronic ischemia
> Connective tissue diseases
> Infections

Restricted filling
> pericardial diseases
> restrictive cardiomyopathy
> tachyarrhythmia

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9
Q

What are the common causes of cardiac failure?

A 
Most to least prevalent
>CAD (coronary artery disease)
> ischemic heart diseases (heart attacks)
> hypertension
> valvular heart disease 
> cardiomyopathies (muscle cell diseases)
> pericardial diseases
> arrhythmias
> high-output conditions
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10
Q

What are high output conditions?

A

eg. anaemia
- low Hb –> low O2 –> heart compensate by pumping harder and faster –> causes high output state

  • due to compensation
  • long run –> heart give up –> CF
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11
Q

What are the causes of left sided heart failure?

A
  • poor output -> less blood supply to the body -> body low of energy, low of oxygen
  • blood congestion: blood coming from lungs into the left atrium –> cannot pump out of left ventricle to the rest of the body –> lungs and heart congested
  • compensation: HF = decreased CO –> increase HR, increase contraction via ANS (sympathetic)
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12
Q

What are the symptoms of left sided heart failure caused by poor output of blood?

A
  • fatigue (low blood to body, low metabolic needs = tired)
  • cyanosis (blue, low blood supply to tissues, no oxygen)
  • confusion (low oxygen to brain)
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13
Q

What are the symptoms of left sided heart failure caused by congestion of blood?

A
  • exertional dyspnea (during exercise)
  • paroxysmal nocturnal dyspnea (lies flat on bed –> blood distribute to lungs –>improve by standing)
  • orthopnea (lungs fully congested)
- pulmonary congestion
> cough
> wheezes
> blood-tinged sputum 
> tachypnea
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14
Q

What are the symptoms of left sided heart failure caused by compensation of low cardiac output?

A
  • tachycardia

- restlessness

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15
Q

What causes right sided heart failure?

A
  • mainly the backlog effect on SVC, IVC
    (blood coming in from SVC and IVC –> into the right atrium –> flows to right ventricle –> but cannot be pumped out to the lungs –> blood gets congested –> whole body is congested –> except the lungs
  • when blood is congested –> forces water to come out of tissues –> leak into body –> body congested with water
  • not caused by cardio problem, but lung problem –> CF
    (eg. lung disease COPD –> blood cannot flow to lungs –> pulmonary vessel resistance -> heart work harder to push blood –> causes hypertrophy –> CF)
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16
Q

What are the symptoms of right sided heart failure?

A
  • may be secondary to chronic pulmonary problems
  • distended jugular veins
  • anorexia and complaints of GI distress
  • weight gain (by water)
  • dependent edema (by gravity, water comes down to legs. if lie down -> water foes to back and face)
  • enlarged liver and spleen
  • ascites (water in abdomen)
  • increased peripheral venous pressure
  • fatigue
17
Q

How does CF be classified on?

A
  1. Systolic Dysfunction

2. Diastolic Dysfunction

18
Q

What happens during systolic dysfunction?

A
  • enlarged ventricles fill with blood -> but ventricles pump out less than 40 - 50% of the blood
19
Q

What happens during diastolic dysfunction?

A
  • the stiff ventricles fill with less blood than normal -> but ventricles pump out about 60% of blood, but the amount may be lower than normal
  • ejection fraction is normal = can pump well but does not receive enough blood
20
Q

How does the heart maintain adequate tissue perfusion (compensation mechanisms)?

A
  1. Increase heart rate
  2. Vascular tone
  3. Circulating Volume
21
Q

What is the role of the sympathetic nervous system when there is decreased cardiac output?

A
  • increases contractility
  • increases heart rate
  • vasoconstriction

= increase cardiac output

22
Q

What is the role of the renin-angiotensin system when there is decreased cardiac output?

A
  • vasoconstriction
  • increase circulating volume/ increase blood volume
  • kidneys receive less blood –> release renin –> convert to angiotensinogen –> Angiotensin 2 –> produce vasoconstrictor –> increase BP

= increase venous return to heart

23
Q

What is the role of the antidiuretic hormone when there is decreased cardiac output?

A
  • increase circulating volume/increase blood volume

= increase venous return to heart

24
Q

What can a chest x-ray result tell you about cardiovascular diseases?

A
  • size and shape of the heart -> cardiomegaly (huge heart size)
    > diameter of heart compared to diameter of chest –> cardiothoracic (CT) ratio must be less than 50%
  • evidence of pulmonary venous congestion (dilated or upper lobe veins –> perivascular edema
    > dilated veins -> venous congestion of fluid on the base area
  • pleural effusion
    > fluid leak into pleural space
25
Q

What is an ECG?

A
  • gold standard investigation
  • assess chamber size –> look for dilation
  • assess systolic function - lvEF
  • assess valve structure and function
  • assess BNP in blood (B-type natriuretic peptide)
    > high sensitivity 89% and specificity 81% for CF
26
Q

What is the treatment of CF?

A
  • correction of reversible causes (treat the primary problems)
    > ischemia/CAD (manage this first then manage CF)
    > valvular heart diseases
    > thyrotoxicosis
    > anaemia
    > arrhythmia
27
Q

What is the management of CF?

A
  • by action of drugs
    > digoxin, inotrope drugs
  • drugs decreases preload –> increases contractility –> decreases afterload

ANP (6 decks)

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