Exam 2 – Cardio Ch 22

Question 1

What does acute moderate heart failure cause?

Answer 1

Immediate depressed pumping ability
Immediate compensation (very severe heart failure)

Question 2

What does immediate depressed pumping ability cause?

Answer 2

Reduced cardiac output
Back up of venous return
Activation of reflexes – baroreceptor and chemoreceptor
If severe, CNS ischemic response

Question 3

What does immediate compensation cause?

Answer 3

Reflexes stimulate sympathetic response
Remaining normal cardiac muscle pumps harder
Maximum by 30 seconds post-insult

Question 4

What can cause cardiac failure?

Answer 4

Trauma
Anemia
Heart valve damage
Myocarditis/bacterial or viral infections
Nutritional deficiency
Myocardial infarction, severe hypertension, AV fistula

Question 5

What is the outcome of acute heart failure?

Answer 5

Survival if sufficient healthy cardiac muscle
Recovery of myocardium
Loss of cardiac reserve (ability to increase cardiac output)
Start of long term compensation

Question 6

What causes the start of long term compensation?

Answer 6

Renin angiotensin system

Retention of fluid and Na

Question 7

What are chronic response to cardiac failure?

Answer 7

Renal Na and H2O retention
Cardiac recovery
Atrial natriuretic peptide causes extra Na excretion

Question 8

What does renal Na and H2O retention cause?

Answer 8

Increase in blood volume and decreases venous resistance
Sympathetic constriction of afferent arterioles leads to decreased GFR and decreased urinary output
Angiotensin II release causes Na retention
Aldosterone release causes Na retention
ADH release cause H2O retention
Decrease in mean arterial pressure, but returns to normal

Question 9

What are features of compensated heart failure?

Answer 9

Normal or close to normal cardiac output
Right atrial pressure increased
Resting HR increased
Air hunger/exercise intolerance
Weight gain from fluid retention
Reduced cardiac reserve

Question 10

What is a cause of decompensated heart failure?

Answer 10

Fluid retention which causes overstretched sarcomeres
Edema of heart muscle
Longitudinal tube of sarcoplasmic reticulum fail to accumulate enough Ca
Norepinephrine in myocardial tissue decreases

Question 11

Look at sarcomere length-tension diagram and decompensated heart failure graph

Answer 11

Look at sarcomere length-tension diagram and decompensated heart failure graph

Question 12

How can decompensated heart failure be treated?

Answer 12

Diuretics
Decrease Na and water intake
ACE inhibitor
Cardiotonic drug
Breath O2
Heart transplant or VAD assist

Question 13

What are the effects of left heart failure?

Answer 13

Left atrial pressure increases
Pulmonary congestion
Pulmonary edema
Arterial pressure may be normal
Cardiac output may be normal (at rest)

Question 14

What happens during left heart failure?

Answer 14

A relatively large amount of blood transfers from the systemic circulation into the pulmonary circulation and causes a big increase if left atrial pressure with cause a normal cardiac output or a slight decrease in cardiac output

Question 15

What does systemic circulation have?

Answer 15

Large volume and capacitance

Question 16

What does pulmonary circulation have?

Answer 16

Small large and capacitance

Question 17

What can right heart failure cause?

Answer 17

Greater decrease in cardiac output than left failure

Peripheral congestion

Question 18

What can peripheral congestion cause?

Answer 18

Bottle jaw
Ascites
Passive liver congestion
Sternal edema
Coughing, restlessness

Question 19

What happens during right heart failure?

Answer 19

A small amount of blood transfers from the pulmonary circulation to the systemic circulation. This causes a small increase in right atrial pressure, which leads to a small decrease or flat cardiac output