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CRT > E4. Heart Failure Patho > Flashcards

E4. Heart Failure Patho Flashcards

1
Q

What is the #1 reason for hospital admission in the U.S?

A

Heart Failure

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2
Q

What is the #1 cause of heart failure?

A

Myocardial Infarction

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3
Q

___________ is a decrease in cardiac output

A

Heart Failure

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4
Q

______ is the amount of blood leaving your heart.

A

Cardiac Output

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5
Q

Cardiac Output Equation

A

SV * HR

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6
Q

Flow of blood through the heart.

A

RA-> RV-> Lungs -> LA-> LV -> Aorta

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7
Q

____________ is when not enough blood is pumped to the lungs.

A

Right-Sided Heart Failure

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8
Q

_____ is when not enough blood is pumped to the aorta to perfuse tissues.

A

Left-Sided Heart Failure.

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9
Q

_____ HF is more common.

A

Left-Ventricular Heart Failure.

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10
Q

____ is the fraction of blood that leaves the ventricle.

A

Ejection Fraction.

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11
Q

HFrEF

A

Heart Failure with reduced ejection fraction.

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12
Q

EF <40% is _______________

A

HFrEF

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13
Q

HFmrEF

A

Heart Failure with mildly reduced ejection fraction.

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14
Q

EF 40-50% is ________________

A

Heart Failure with mildly reduced ejection fraction.

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15
Q

HFpEF

A

Heart Failure with preserved ejection fraction.

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16
Q

EF >50% with heart failure is _____________

A

HFpEF

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17
Q

Diastolic Heart Failure is also known as ______

A

HFpEF

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18
Q

____ is when not enough oxygenated blood is moving forward from the heart to perfuse the vital organs.

A

Hypoperfusion.

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19
Q

____ is when blood backs up from the LV to the lungs, possible the RV.

A

Congestion

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20
Q

What are the two major clinical presentations of HF?

A
  1. Hypoperfusion.
  2. Congestion.
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21
Q

What are these signs of?

Tachycardia, Fatigue, Cyanosis, Cold Extremities, Organ Dysfunction

A

Hypoperfusion

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22
Q

What are these signs of?

Weight gain, SOB, Orthopnea, Paroxysmal nocturnal dyspnea, pleural effusion on CXR, crackles/rales on auscultation, S3 and S4, peripheral edema, BNP, JVD

A

Congestion

23
Q

ACC Class A Heart Failure

A

Patient is at risk for structural heart disease and does not have symptoms.

24
Q

ACC Class B Heart Failure

A

Patient has structural heart disease without symptoms.

25
Q

ACC Class C Heart Failure

A

Patient has structural heart disease and symptoms.

26
Q

ACC Class D Heart Failure

A

Patient has structural heart disease and refractory symptoms.

27
Q

NYHA Class I Heart Failure

A

No limitation on ordinary activity.

28
Q

NYHA Class II Heart Failure

A

Slight symptoms with activities of daily living.

29
Q

NYHA Class III Heart Failure

A

Extreme symptoms with activities of daily living.

30
Q

NYHA Class IV Heart Failure

A

Symptoms even at rest.

31
Q

Heart Failure is diagnosed using _____

A

Echocardiograms.

32
Q

The pathophysiology of HF is all related through ____.

A

Baroreceptor activation.

33
Q

What four pathophysiologic responses result from baroreceptor activation in heart failure?

A
  1. Catecholamine Release
  2. Juxtaglomerular Apparatus (Renin Release)
  3. Sodium and Water Retention
  4. Alpha-1 Stimulation.
34
Q

Following baroreceptor activation, what catecholamines are released?

A

NE and Epi

35
Q

NE and Epi stimulate _____ in the short term.

A

B-1 receptors in the heart—> this increases cardiac contractility in the short term.

36
Q

NE and EPI release lead to what in the long term.

A
  1. Apoptosis and muscle burn out (Ventricular Remodeling)
  2. B-1R desensitization
  3. Change in B1:B2 ratio.
  4. Uncoupling of B1 Receptors (myocytes don’t contract)
37
Q

In HF, how does the ratio of Beta receptors change on the heart?

A

Changes from 80:20 (B1:B2) to 60:40

38
Q

Following baroreceptor activation, the juxtaglomerular complex releases ____, which stimulates AGII.

39
Q

What does Angiotensin II production lead to?

A
  1. Vasoconstriction
  2. Na and water retention
  3. NE and Aldosterone Release
  4. Cardiac Remodeling
  5. ADH release
40
Q

______ release leads to ventricular remodeling and promotes potassium and magnesium excretion.

A

Aldosterone

41
Q

In response to baroreceptor activation, ____ receptors are stimulated leading to vasoconstriction. This results in an increase in afterload, making it more difficult for the LV to pump. Overtime this leads to cardiac hypertrophy and remodeling.

A

Alpha-1-Receptors.

42
Q

What is the #1 cause of death in a patient with HF?

A

Ventricular tachycardia/fibrillation. (This results from B-1 stimulation and ventricular remodeling).

43
Q

____ is a rapid onset of HF symptoms causing clinic, ED, and hospital admission.

A

Acute Decompensated Heart Failure (ADHF) –> Heart Failure Exacerbation.

44
Q

What are the three primary causes of ADHF?

A
  1. Noncompliance (diet and medications).
  2. NSAID use
  3. Comorbidities
45
Q

How do NSAIDs cause ADHF?

A

Lead to fluid retention

46
Q

What comorbidities may lead to ADHF?

A
  1. Atrial Fibrillation
  2. MI
  3. Infection
47
Q

Warm

A

High Perfusion

48
Q

Cold

A

Poor Perfusion

49
Q

Wet

50
Q

Dry

A

Not Congested

51
Q

Class 1 ADHF

A

Warm and Dry
(Perfusing, not congested)

52
Q

Class II ADHF

A

Warm and Wet
(Perfusing and Congested)

53
Q

Class III ADHF

A

Cold and Dry
(Not perfusing and not congested)

54
Q

Class IV ADHF

A

Cold and Wet
(Not perfusing and congested)

NOT GOOD!!!!!

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