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2 - CVS > deck_835165 > Flashcards

deck_835165 Flashcards

1
Q

Define 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

Give some chronic causes of L heart failure

A

Systemic hypertensionArrhythmiasCoarctation of the aortaAnaemiaThyrotoxicosisIschaemic heart disease

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3
Q

Give some chronic causes of R heart failure

A

Pulmonary hypertension Arrhythmias Chronic lung diseaseChronic pulmonary/tricuspid valve dysfunctionLeft to right shuntLeft heart failure

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4
Q

Give some acute causes of R heart failure

A

Pulmonary embolism Rupture of tricuspid valve cusp

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5
Q

Give some acute causes of L heart failure

A

Myocardial infarctionRupture of mitral or aortic valve

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6
Q

What are some causes on congestive heart failure?

A

ThyrotoxicosisLesions of the aortic and mitral valvesAnaemia

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7
Q

What are the 6 compensatory mechanisms for heart failure?

A

SNS activationRAAS activationAnti-diuretic hormonesNitric-oxideProstaglandin E2 and I2 Hypertrophy of cardiac muscle

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8
Q

How is the sympathetic nervous system activated?

A

Falls in BP and blood volume are detected by baroreceptors in the aortic arch and carotid sinus

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9
Q

What does the SNS do to compensate in heart failure?

A

Increased HR and force of contraction –> increase cardiac output and then increasing the work load of the heartSecretes renin to activate RAAS

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10
Q

What does vasoconstriction of the arterioles of?

A

increases the blood pressure and the after load

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11
Q

How can left heart failure cause right heart failure?

A

Left heart failure raises pulmonary arterial pressure which the causes right heart failure

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12
Q

What is the name used when both ventricles are affected in heart failure?

A

Congestive heart failure

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13
Q

Why are the sympathetic nervous system and the renin-angiotensin-aldosterone-system activated in heart failure?What affect do they have?

A

To maintain cardiac outputThey cause the struggling heart to work harder

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14
Q

How if the RAAS activated?

A

Caused by reduced blood flow to the kidneys and SNS causing renin secretion. Causes endothelin secretion by vascular endothelial cells. Leads to renal vasoconstriction which activates RAAS

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15
Q

What does the RAAS do?

A

Angiotensin is converted to angiotensin 1 by renin. Angiotensin 1 is converted to angiotensin 2 by angiotensin converting enzyme. Angiotensin 2 promotes vasoconstriction and aldosterone release from the adrenal cortex.

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16
Q

What effects does aldosterone have?

A

Increases BP, NA and H2O retention by the kidneys causing and increase in blood volume, increasing venous return and stroke volume.

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17
Q

Why are diuretics used in heart failure?

A

You want to prevent water retention and increased blood volume in order to limit oedema

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18
Q

When does peripheral oedema occur?

A

Due to right-sided heart failure. Failure to pump correctly causes and increase in venous pressure and capillary pressure, forcing fluid out into the tissues.

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19
Q

When does pulmonary oedema occur?

A

Due to left-sided heart failure. Causes an increased left-atrial pressure which also causes a rise in pressure of the vessels in the pulmonary circulation. (Also increases pulmonary artery pressure due to low resistance of these vessels)

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20
Q

Define systolic dysfunction

A

The impaired ability of the heart to contract

21
Q

Define diastolic dysfunction

A

Impairment of the filling of the heart.

22
Q

What does heart failure cause?

A

Systolic dysfunctionDiastolic dysfunctionIncreases ADH secretionInhibits nitric oxide secretion

23
Q

What causes heart failure?

A

Ischaemic heart disease is the most common cause of heart failure– myocardial infarction, valve rupture, hypertension (pulmonary and systemic), congenital heart diseases, anaemia, chronic lung disease

24
Q

What can happen to the heart muscle itself to compensate in heart failure?

A

Hypertrophy of cardiac muscle causes a decreased ventricular volume which worsens the decreased cardiac output causing the heart to remodel and dilate.

25
Q

What are the signs and symptoms of left heart failure?

A

Fatigue (C output doesn’t meet needs)Exertional dyspnoea (cant meet increased demand)Pulmonary oedema (increased venous pressure …)Displaced apex beat and cardiomegaly (due to LV hypertrophy)Tachycardia (sympathetic response to decreased CO)

26
Q

Give some characteristics of pulmonary oedema

A

Increased venous pressure –> increased hydrostatic pressure in capillaries –> fluid moves into tissuePULMONARY CRACKLES: fluid collects in the bottom of the lungs when uprightORTHOPNOEA: fluid distributes when lying down, causing BREATHLESSNESS from impaired gas exchangeCYANOSIS: impaired gas exchanges leads to hypoxaemia

27
Q

Why is fatigue presents in right heart failure?

A

Decreased flow to the lungs results in hypoxaemia due to a ventilation/perfusion mismatch. Insufficient oxygen for metabolic needs.

28
Q

Why is breathlessness present in right heart failure?

A

Decreased oxygenated blood enters systemic circulation. Hyperventilation results in order to increase the partial pressure of oxygen.

29
Q

What causes raised jugular venous pressure?

A

Failure of right side of the heart to pump in right heart failure causes a rise in venous pressure and distension of the jugular veins.

30
Q

What is pitting oedema and why does it occur?

A

Oedema that when you press down on, leaves and indentation in the skin. It is due to increased venous pressure –> increased hydrostatic pressure in capillaries –> fluid leaks out into the interstitium

31
Q

Why does hepatomegaly occur in right heart failure?

A

Bloods backs up into inf. vena cava causing congestion of the hepatic veins –> hepatic engorgement.

32
Q

What areas in the body are targeted fro drugs to help regulate the cardiac output?

A

KIDNEYS: regulate blood volume (Na and H20 reabsorption)ARTERIOLES: regulate blood pressureMYOCARDIUM: regulates force of contraction (depends on degree of stretch)SAN: regulates heart rate

33
Q

What are the main changes that are made in order to manage heart failure?

A

Lifestyle – diet, exerciseDrugs if lifestyle changes have been changed and are having little/need more of an effect1. antihypertensives2. beta-blockers to reduce cardiac workload3. positive inotropes4. anti-arrhythmic drugs

34
Q

Name some anti-hypertensive drugs

A

alpha-1 antagonistsDiuretics e.g. loop diuretics & spironolactoneACE-inhibitors

35
Q

What happens in right heart failure?

A

Right heart does not work properly and leads to an increased venous pressure causing oedema due to increased venous pressure increasing the hydrostatic pressure in the capillaries.

36
Q

What is nocturia and why does it occur?

A

Frequent urination throughout the night. Due to fluid which has been built up in ankles/legs returns to the blood stream when lying down

37
Q

What are the characteristic signs of right heart failure?

A

Pitting peripheral oedemaRaised jugular venous pressureFatigueHepatomegalyBreathlessnessAscites

38
Q

Generally, what does left heart failure have an effect on?

A

Lung function

39
Q

Generally, what does right heart failure have effects upon?

A

Differing areas in the systemic circulation

40
Q

What tends to me the main cause of right heart failure?

A

Tends to be secondary to left heart failure

41
Q

What are some common signs of left heart failure?

A

Increased breathing rate (tachypnea) and increased work of breathing

42
Q

When does cyanosis occur in left heart failure?

A

It is quite rare as it is a late sign of severe pulmonary oedema

43
Q

What are the main causes of congestive heart failure?

A

Ischaemic heart diseaseCigarette smokingHypertensionObesity DiabetesValvular heart disease (usually older populations)

44
Q

How is the severity of heart failure determined and how are they differentiated?

A

Heart failure is divided into classes depending on the the impact on life and physical exertionClass 1 = lowest severityClass 4 = more severe

45
Q

Describe the different classifications of heart failure

A

Class 1 = No symptomatic limitation of physical activityClass 2 = Slight limitation of physical activity with ordinary physical activity resulting in symptoms. Have no symptoms at restClass 3 = Marked limitation of physical activity with less than ordinary activity causing symptomsClass 4 = Unable to carry out physical activity without symptoms and may have symptoms at rest. Increased discomfort with any kind of physical activity

46
Q

What stimulates renin release from the kidneys?What does renin do?

A

Drop in blood pressureCatalyses conversion of angiotensin to angiotensin 1

47
Q

What effects does the sympathetic nervous system have on blood vessels?

A

Activates the alpha-1 receptor which causes vasoconstriction of blood vessels, increasing blood pressure which increase the after-load and the preload of the heart therefore increasing the whole workload of the heart Also affects beta-1 receptors in order to increase the chronotropy and inotrophy of the heart

48
Q

What affect do ACE inhibitors have?

A

Prevents conversion of angiotensin 1 to angiotensin 2. Has an indirect vasodilatory and diuretic effect, which decrease the workload on the heart.

49
Q

Why can increasing the action of the RAAS be detrimental?

A

Angiotensin 2 has a number of effects on certain organsIncreases atherosclerosis, vasoconstriction, vascular hypertrophy, endothelial dysfunction –> STROKE and HYPERTENSION LV hypertrophy, fibrosis and apoptosis in the heart –> MICan cause GFR, Proteinuria, Aldosterone release and glomerular sclerosis which can lead to RENAL FAILURE

2 - CVS (28 decks)

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