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Cardiovascular Module > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Heart failure

A

inability of the heart to pump blood at the required rates for normal metabolic activity

inability of the heart to only pump bloods at an elevated filling pressure

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2
Q

Mechanisms of cardiac dysfunction

A 
Pump failure 
obstruction to flow 
regurgitant flow 
conduction defects
 compromised ventricular filling 
obligatory high output states 
Loss of continuation of the circulatory system
Any severe cardiac disease
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3
Q

Pump failure

A

damaged muscle (IHD)

Intrinsic contractile failure is ( dilated cardiomyopathy)

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4
Q

Obstruction to flow

A

Overwork of the chamber proximal to the obstruction ( HPT, Aortic mitral stenosis ..)

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5
Q

Regurgitant flow

A

Volume overload (mitral and aortic incompetence)

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6
Q

Conduction defects

A

Uncoordinated generation or blockage of cardiac impulses

non-uniform and inefficient contraction of the myocardium ( heart block, v. Fibrillation)

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7
Q

Obligatory high output states

A

Increased work of the heart ( anemia…)

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8
Q

Loss of continuation of the circulatory system

A

Allows escape of blood (rupture of myocardium aneurysm)

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9
Q

Factors affecting features of cardiac failure

A

Age
Speed of onset
presence of other systemic disease

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10
Q

Types of cardiac failure

A 
Acute failure 
chronic failure 
low output failure 
High output failure
 forwards failure 
backward failure 
systolic failure 
Diastolic failure
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11
Q

Acute failure

A

Due to sudden loss of contractility ( MI) or sudden overload (regurgitation due to valve rupture )

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12
Q

Chronic failure

A

Over a period of years (HPT..)

After an episode of acute failure

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13
Q

Low output failure

A

failure of the heart to pump normally

Cardiac output fails to increase or decline during exercise , or decline during rest

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14
Q

High output failure

A

Cardiac failure even if cardiac output is normal or elevated

Due to either blood volume increase, increased venous return , decreased peripheral resistance

come with tachycardia and Gallop rhythm

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15
Q

Forward failure

A

Diminished CO

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16
Q

Backwards failure

A

Damming back of blood in venous system

17
Q

Systolic failure

A

Systolic ventricular dysfunction
Loss of contractility

dilated ventricles which fails to contract normally

low systolic ejection and cardiac output

18
Q

Diastolic failure

A

Impaired myocardial relaxation

Ventricular wall stiffness 
decreased ventricular compliance 
impaired diastolic filling 
low cardiac output 
Systolic normal 
Damming back of blood in the venous system
19
Q

Two phases of genesis of cardiac failure

A

Compensatory phase

progression to failure phase

20
Q

Compensatory phase

A

Changes in the heart and peripheral vascular system to maintain:
CO
Arterial pressure
Peripheral perfusion

Do it by :
raised ventricular filling pressure
Myocardial structural changes
activation of neuro hormonal systems

21
Q

Raised ventricular filling pressure

A

Increased preload -> stretching of walls -> increased contractility -> increased CO

22
Q

Myocardial structural changes

A

Ventricular hypertrophy To increase capacity for Ventricular work and maintain cardiac performance

23
Q

Activation of neuro hormonal systems

A

Increased Noradrenaline-> increase cardiac contraction and HR

Activation of RAAS -> sodium and water retention -> increased blood volume -> increased preload -> increased CO

Increased natriuretic peptide level when right atrial pressure high -> reduces preload, and afterload

24
Q

Progression to failure

A

Cardiac hypertrophy leading to high demand for O2 but decreased capillary density and fibrous tissue deposition

Increased protein synthesis for formation of embryonic Fetal isoforms of contractile proteins with lower ATPase activity

Activation of fœtal proteins

Alteration in calcium handling and subendocardial ischemia impair contraction and relaxation

Reduced catecholamines

B1 receptor density reduced

Sensitivity of myocardium to b Adrenergic stimulation depressed

RAAS activation causing vasoconstriction with increased afterload and increased preload so more cardiac work

Plasma arginine vasopressin causing water retention and lead to hyponatremia

25
Q

Left sided heart failure causes

A

Build up of blood within pulmonary circulation

Reduced peripheral blood flow and pressure

26
Q

Pulmonary changes of left ventricular heart failure

A 
Pulmonary congestion 
Pulmonary edema 
Heavy lungs 
Heart failure cells in alveoli (proteins phagocytosed by macrophages) 
Dyspnoea 
Orthopnea 
Paroxysmal nocturnal dyspnoea
27
Q

Renal changes in left ventricular failure

A

Cardiac output decreased so reduced renal blood flow
Prerenal failure
High urea and creatinine levels
RAAS activation So Increased sodium and water retention
More pulmonary edema and peripheral edema

28
Q

Cerebral changes in LV heart failure

A 
Cerebral hypoxia 
Hypoxia encephalopathy with irritability 
Loss of attention span 
Restlessness 
Coma
29
Q

Right sided heart failure causes

A

Mostly due to left sided heart failure

Pure right sided heart failure rare and due to chronic lung disease with severe pulmonary hypertension (cor pulmonale, pressure overload, increased resistance)

30
Q

Cardiac changes in RV heart failure

A

RV and RA hypertrophy and dilatation

31
Q

Liver portal system and spleen changes in RV heart failur

A

Enlargement due to passive congestion

Nutmeg appearance of liver due to congestion around hepatic venues with fatty periportal zones

Cardiac cirrhosis or sclerosis caused by Hypoxia causing perivenular necrosis and fibrosis

Portal hypertension and congestive splenomegaly due to congestion

Ascites due to transudate accumulation in peritoneal cavity

32
Q

Renal changes in RV heart failure

A

Congestion so RAAS activated
Salt and water retention
Edema formation

33
Q

Cerebral changes in RV heart failure

A

Hypoxic encephalopathy

34
Q

Edema in RV heart failure

A

Pedal edema
Pretibial edema
Sacral or presacaral edema
Sometimes anarsaca

Cardiovascular Module (21 decks)

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