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PHA 222 > Heart Failure 1&2 > Flashcards

Heart Failure 1&2 Flashcards

1
Q

define heart failure

A

many definitions- preferred one: a clinical syndrome characterised by its impaired cardiac pumping, leading to the inability of the heart to deliver enough blood to its peripheral tissues and meet metabolic physiological demands, and by impede venous return, leading to its systemic and or pulmonary congestion.

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2
Q

what are the two clinical features that characterised heart failure

A

forward failure- reduced cardiac output

backward failure- congestion

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3
Q

how do you classify heart failure?

A

it is based on the left ventricular ejection fraction(LVEF) and predominant underlying cardiac dysfunction

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4
Q

what are the two classifications of heart failure?

A

1- heart failure with reduced ejection function (HF-REF

2- heart failure with preserved ejection function (HF-PEF)

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5
Q

What is HF-REF characterised by?

A

the inability to contract properly

LVEF less than 40%

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6
Q

what is HF-PEF characterised by?

A

normal LVEF

inability to relax effectively

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7
Q

what are the two types of heart failure you can get?

A

Acute heart failure(decompensated)

chronic heart failure(compensated)

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8
Q

what are the 4 features of acute heart failure?

A

rapid onset
sudden decline in cardiac function
potentially life threatening
may be new or an exacerbation of chronic heart failure

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9
Q

what are the 2 features of chronic heart failure

A

slow more insidious symptoms of heart failure

characterised by the ability to maintain cardiac perfusion in the face of long term cardiac dysfunction

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10
Q

what are the 4 classifications of causes of heart failure

A

intrinsic myocardial damage-CAD / IHD, cardiomyopathy
pressure overload –hypertension, pulmonary HPT, aortic stenosis
volume load –aortic or MV regurgitation, VS defect
inadequate filling –AF, arrhythmia, constrictive pericarditis, etc

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11
Q

name 4 commodities associated with HF-PEF

A

obesity, hypertension, type 2 diabetes, atrial fibrillation

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12
Q

Medical conditions associated with heart failure

A

anemia/kidney failure/diabetes/obesity/disordered breathing during/ thyroid disorders/ side effects of medicine

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13
Q

what are the 3 Pathophysiological mechanisms associated with HF-REF

A

‘Cardiorenal’ model
‘Cardio-circulatory’ model
Neurohormonal’ model

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14
Q

What is the cardiorenal model?

A

fluid retention 2to forward failure & reduced renal blood flow

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15
Q

what is the cardio-circulatory model?

A

forward failure in face of peripheral vasoconstriction &
increase PVR

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16
Q

what is the neurohormonal model?

A

maladaptive neurohormonal activation cardiac remodelling

17
Q

cardiac dysfunction causes a drop in what?

A

CO= reduced bp and reduced organ perfusion= activation of neurohormonal pathways

18
Q

what are the effects of these neurohormonal pathways long term and short term?

A

short term- beneficial

long term- progressive deterioration of cardia function

19
Q

what effects does the neurohormonal model produce on the central nervous system?

A

increase of circulating catecholamines (noradrenaline & adrenaline)
Increased secretion of renin-activation of the Renin-Angiotensin-Aldosterone System (RAAS)

20
Q

what do catecholamines do?

A

aggravate ischaemia, potentiate arrhythmias, are directly toxic to myocytes, and promote cardiac remodelling

21
Q

what does increasing circulating angiotensin 2 do?

A

inc systemic vasoconstriction

peripheral nervous system activation

22
Q

what does increasing aldosterone do?

A

increases sodium & water retention
endothelial dysfunction
organ fibrosis

23
Q

what happens when you increase ADH

A

increase in water retention and vasoconstriction

24
Q

what is monocyte hypertrophy?

A

when one side of the heart wall increases in size to pump blood around the body,

25
Q

where do ANP and BNP cells come from?

A

ANP come from the atria, but ventricular cells also secrete them when under pressure.
BNP cells come from ventricular cells

26
Q

what is cardiac remodelling? is it good or a bad thing?

A

Cardiac remodeling is defined as a group of molecular, cellular and interstitial changes that manifest clinically as changes in size, mass, geometry and function of the heart after injury.
it is a bad thing and can lead to heart failure

27
Q

what are the two clinical features of heart failure in relation to the right and left ventricular failure?

A

left
forward=hypofusion( decrease in CO) -pulmonary oedema backward=congestion
right forward=hypofustion- ankle/hepatic odeema backward=congestion

28
Q

what are the signs of left heart failure?

A

decreased cardiac output/ pulmonary congestion-impared gas exhange/pulmonary oedmea- cough w/ froty septum and paroxymal noctunurl dyspnea

29
Q

what are the signs of right heart failure

A

congestion of peripheral tissues- liver congestion- anorexia/ GI distress/ weightloss

30
Q

what are the 3 diagnosis criteria of EF HF?

A

1- symptoms of a heart failure-breathlessness/fatigue
2-signs of typical heart failure
3- objective abnormality of a structural or functional abnormality of the heart

31
Q

what is the NYHA ? and what is their classifications of HF?

A 
New York Heart Association
class 1-4, 4 being the moat severe
32
Q

what is stage 1 of NYHA?

A

⚫Ordinary physical activity does not cause undue fatigue, palpitationor dyspnoea

33
Q

What is stage 2 of NYHA?

A

⚫Comfortable at rest

⚫Ordinary physical activity results in fatigue, palpitation or dyspnoea

34
Q

what is stage 3 of NYHA?

A

⚫Comfortable at rest

⚫Less than ordinary physical activity causes fatigue, palpitation or dyspnoea

35
Q

what is stage 4 of NYHA?

A

⚫Symptoms of cardiac insufficiency may be present at rest

⚫lf any physical activity is undertaken, discomfort is increased

36
Q

what is the AAC/AHA classification of HF?

A

A-D ,d being the worse

PHA 222 (40 decks)

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