Heart Dis-Ease

Question 1

Major sources of cardiac pain

Answer 1

1. Myocardial Ischemia

2. Pericarditis

Question 2

Circulatory Failure is associated with

Answer 2

an inability to maintain adequate blood flow to the tissues

1. Acute Heart Failure
2. Chronic Heart Failure
3. Compensatory mechanisms
4. Decompensation

Question 3

Contributing factors to circulatory failure

Answer 3

1. Insufficient cardiac output (heart failure)

2. Marked reductions in circulating blood volume (hemorrhage, acute dehydration, septic shock)

Question 4

Acute Heart Failure: Course

Answer 4

Rapidly progressive; associated with medical emergencies

Question 5

Acute Heart Failure: Causes

Answer 5

infarcts, aortic/ventricular rupture, cardiac arrest, large emboli

Question 6

Chronic (Congestive) Heart Failure (CHF): onset is preceded by

Answer 6

1. Myocardial hypertrophy

2. Compensatory response to increased workload in a compromised heart

Question 7

CHF: Populations

Answer 7

1. 5 million affected each year

2. 2% at 50 => 10% at 80

Question 8

CHF: Prognosis

Answer 8

1. Recurrent with poor prognosis

2. 300,000 deaths due to CHF

Question 9

CHF: General Features

Answer 9

1. Congestion
2. Pooling of blood in veins
3. Reduced/Low arterial flow

Question 10

CHF Underlying causes

Answer 10

1. Myocardial dysfunction
2. Impaired ventricular filling
3. Increased cardiac workload

Question 11

CHF: Myocardial dysfunction: General features

Answer 11

1. Most common
2. Ischemic and Non-ischemic
3. Conduction disturbances

Question 12

CHF: Impaired ventricular filling: associated with

Answer 12

1. Increased cardiac stiffness (diastolic dysfunction

Question 13

CHF: Impaired ventricular filling: Causes

Answer 13

1. L. ventricular hypertrophy
2. amyloid
3. pericardial fibrosis
4. rigidity

Question 14

CHF: Increased cardiac workload: synonyms

Answer 14

1. hypertenstion
2. valve lesions
3. high output failure

Question 15

Compensatory mechanisms: definition

Answer 15

Mechanisms that are activated in order to maintain adequate blood flow. They may initially maintain cardiac output at adequate levels, but they also contribute signs of heart failure and other deleterious effects

Question 16

Compensatory mechanisms: types

Answer 16

1. Ventricular dilatation
2. Myofiber hypertrophy
3. Neurohumoral mechanism activation

Question 17

Ventricular dilatation: Mechanism

Answer 17

improves contraction by stretching the myofibers according the the Frank Starling mechanism

Question 18

Myofiber hypertrophy: Mechanism

Answer 18

increased myocardial mass augments contractile forces

Question 19

The 3 types of Nuerohumoral mechanisms

Answer 19

1. Increased sympathetic nerve activity
2. Activate the renin-angiotensin-aldosterone system
3. Secretion of atrial natriuretic peptide

Question 20

Neurohumoral mechanism: Sympathetic activity

Answer 20

1. serves to increase heart rate
2. augment ventricular contraction
3. activate vasomotor responses

Question 21

Neurohumoral mechanism: Renin-Angiotensin-Aldosterone

Answer 21

1. Promote retention of Na and Water

2. Expand the circulating blood volume

Question 22

Decompensation: Definition

Answer 22

associated with a decreased ability to maintain minimum levels of output.

Question 23

Decompensation: Circulatory disturbances are

Answer 23

1. more severe
2. progressive
3. symptomatic
4. supportive therapy is required if patient is to survive

Question 24

Decompensation: Therapeutic agents

Answer 24

Concerned with improving the unwanted effects of pulmonary congestion and fluid retention to improve Cardiac Output

1. Diuretics, nitrates, ACE
2. Digitalis to augment myocardial contraction

Question 25

Decompensation: Contributing factors

Answer 25

1. Progressive deterioration 2. Increased circulating blood volume 3. Hypertrophy of myocardium

Question 26

Decompensation: Progressive deterioration

Answer 26

Progressive deterioration of the myocardium due to underlying disease 1. Fibrosis 2. Chronic ischemic atrophy

Question 27

Decompensation: Increased circulating blood volume

Answer 27

1. Places an additional hemodynamic burden on the heart 2. ultimately contributes to ventricular dilation and over-stretching 3. decreased force of contraction (Frank Starling)

Question 28

Decompensation: Hypertrophy of Myocardium: Definition

Answer 28

Increased thickness of . ventricle and increased mass

Question 29

Decompensation: Hypertrophy of Myocardium: Pathologic changes lead to:

Answer 29

Anatomical and Physiological changes that compromise cardiac function

Question 30

Decompensation: Hypertrophy of myocardium: Pathological hypertrophy include

Answer 30

1. Appearance of abnormal myosin 2. myocardial fibrosis 3. decresed capillary to myocyte ratio 4. decreased sequestration of calcium 5. diminished sympathetic function 6. decreased beta-adrenergic r/c's and depletion of catecholamines in sympathetic terminals

Question 31

Features of Heart Failure

Answer 31

1. Left side (ventricular) | 2. Right ventricular failure

Question 32

Heart Failure: Left Side: Etiology

Answer 32

1. Coronary Heart Disease 2. Systemic hypertension and its complications 3. Aortic and mitral valve disease - stenosis/insufficiency 4. Congenital conditions - septal defects, patent ductus arteriosus, aortic coarctation 5. Cardiomyopathy

Question 33

Heart Failure: Manifestations

Answer 33

1. Pulmonary congestion 2. Reduced output 3. Tachycardia - "weak pulse" 4. "Poor circulation" with reduced tolerance to cold temperatures

Question 34

Heart Failure: Manifestations: Pulmonary Congestion: Cause

Answer 34

Congestion of the left ventricle contributes to elevated pulmonary venous pressure and pulmonary edema.

Question 35

Heart Failure: Manifestations: Pulmonary Congestion: Symptoms

Answer 35

1. Dyspnea after rest or exercise | 2. Othopnea

Question 36

Orthopnea: definition

Answer 36

feeling of being out of breath when lying flat, and improves when sitting up

Question 37

Heart Failure: Manifestations: Pulmonary Congestion: Paroxysmal nocturnal dyspnea: Cause

Answer 37

when edema fluids from the periphery are redistributed to the lungs wen the patient lies flat at night. Gives rise to rapidly progressive dyspnea which makes the patient sit up or lean out of the window to get "fresh air"

Question 38

Heart Failure: Manifestations: Pulmonary Congestion: Paroxysmal nocturnal dyspnea: other features

Answer 38

1. Dyspnea and increased fatigue with mild exercise 2. Pulmonary "Rales" 3. Large volumes of frothy white sputum that may be tinged with blood (rusty sputum) 4. Pleural effustion - severe may compress lungs

Question 39

Heart Failure: Manifestations: Reduced Output

Answer 39

Forward Failure

Question 40

Heart Failure: Manifestations: Reduced Output: Contributes to

Answer 40

low cardiac output contributes to decreased arterial perfusion and systemic hypoxia

Question 41

Heart Failure: Manifestations: Reduced Output: Renal ischemia activates...

Answer 41

activates vasopressor mechanisms and contributes to increased retention of fluids 1. vasopressor mechanisms activated 2. severe renal ischemia may cause tubular injury and renal failure

Question 42

Heart Failure: Manifestations: Reduced Output: Advanced stages

Answer 42

Organs may become hypoxic | CNS - anxiety, reduced attention span, restlessness, irritability, visual dimness

Question 43

Mitral stenosis contributes to pulmonary hypertension and right ventricular failure, BUT...

Answer 43

this develops in the absence of left ventricular failure.