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TAS Cardiology > Heart Failure ✅ > Flashcards

Heart Failure ✅ Flashcards

1
Q

What is heart failure?

A

When the heart is unable to maintain adequate perfusion of the tissues for normal metabolism

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2
Q

What can the causes of heart failure be divided into?

A
  • Volume overload
  • Pressure overload
  • Cardiac arrhythmias
  • Ventricular dysfunction
  • Other
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3
Q

What are the causes of volume overload leading to heart faiure?

A
  • Left-to-right shunts
  • Valvular regurgitation
  • Complex regional cardiac lesions
  • Arteriovenous malformations
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4
Q

Give 2 arteriovenous malformations that can lead to heart failure?

A
  • Vein of Galen

- Haemangioma

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5
Q

What can cause pressure overload leading to heart failure?

A
  • Left heart obstruction
  • Acute hypertension
  • Right heart obstruction
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6
Q

Give 3 causes of left heart obstruction leading to heart failure

A
  • Aortic stenosis
  • Coarctation of the aorta
  • Hypoplastic left heart
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7
Q

Give 2 causes of acute hypertension that can lead to heart failure?

A
  • Haemolytic uraemic syndrome

- Glomerulonephritis

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8
Q

Give a cause of right heart obstruction that can lead to heart failure

A

Pulmonary stenosis

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9
Q

What cardiac arrhythmias can lead to heart failure?

A
  • Congenital complete heart block
  • Supraventricular tachycardia
  • Ventricular tachycardia
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10
Q

What causes of ventricular dysfunction can lead to heart failure?

A
  • Myocarditis
  • Cardiomyopathy
  • Sepsis
  • Anaemia
  • Pericardial effusion/cardiac tamponade
  • Ischaemia
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11
Q

What kinds of cardiomyopathy can lead to heart failure?

A
  • Dilated
  • Hypertrophic
  • Restrictive
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12
Q

What can cause ventricular ischaemia leading to heart failure?

A
  • Birth asphyxia

- Anomalous left coronary artery

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13
Q

What is the most likely underlying cause of heart failure dependent on?

A

The age of the child

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14
Q

What is the most likely underlying cause of heart failure in neonates and infants younger than 2 months?

A

Structural heart diesaes

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15
Q

What are the other causes of heart failure?

A
  • Chronic hypertension
  • Renal failure
  • Metabolic disorders
  • Endocrine disorders
  • Anaemia
  • Illicit or accidental drug ingestion
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16
Q

What happens to the heart muscle in chronic heart failure?

A

There is a decrease in contractility of the affected heart muscle

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17
Q

What effect does the decrease in contactility of the heart muscle in chronic heart failure have on the Starlin curve?

A

It shifts it to the right

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18
Q

What is the implication of the reduced contractility of the heart in chronic heart failure?

A

Increasing preload has a smaller effect on stroke volume than seen in a healthy heart, leading to a low cardiac output state

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19
Q

What does the low cardiac output state trigger in chronic heart failure?

A

Cardiac, autonomic, and hormonal compensatory changes

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20
Q

What do cardiac compensatory changes aim to do in the low cardiac output state of chronic heart failure?

A

Increase stroke volume

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21
Q

What do attempts to increase stroke volume through cardiac compensatory mechanisms in chronic heart failure lead to?

A

Increased wall tension

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22
Q

What effect does the increased wall tension due to cardiac compensatory mechanisms in chronic heart failure have?

A

Increases oxygen consumption of the myocardium

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23
Q

What structural changes can develop to compensate in chronic heart failure?

A

Cardiac hypertrophy or dilatation

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24
Q

Why might cardiac hypertrophy or dilatation develop in chronic heart failure?

A

To try and balance the increased presure and keep the wall stress unchanged

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25
Q

What might be required to treat cardiac dilation in chronic heart failure?

A

Diuretics

26
Q

Why are diuretics used to treat dilation of the heart in chronic heart failure?

A

To reduce the preload

27
Q

What autonomic compensatory changes might develop in early heart failure?

A

Increase in sympathetic stimulation

28
Q

What triggers the increase in sympathetic stimulation in early heart failure?

A

Baroreceptors

29
Q

How is increased sympathetic stimulation achieved in autonomic compensation for early heart failure?

A

Increased adrenal secretion of adrenaline and neural release of noradrenaline

30
Q

What is the result of increased adrenaline and noradrenaline in early heart failure?

A
  • Increases heart rate
  • Increases cardiac contracility
  • Increases blood pressure
31
Q

How does adrenaline and noradrenaline increase the blood pressure in early heart failure?

A

By causing peripheral vasoconstriction

32
Q

What negative effect can autonomic compensaotry changes in heart failure?

A

In the failing heart, the increase in afterload increases cardiac demands and will eventually further depress cardiac output

33
Q

What effect does chronic adrenergic stimulation secondary to autonomic compensatory changes in chronic heart failure have?

A
  • Hypermetabolism
  • Arrhythmogenesis
  • Direct myocardial toxicity
34
Q

What effect does chronic adrenergic stimualtion have on the myocardium?

A
  • Apoptosis
  • Hypertrophy
  • Focal myocardium
35
Q

What does chronic exposure to high catecholeamine levels secondary to autonomic compensatory changes in chronic heart failure result in?

A

Decreased density of ß-adrenergic receptors on the myocardial surface

36
Q

What does a decreased density of ß-adrenergic receptors on the myocardial cell surface result in?

A

Functional loss of the catecholamine-mediated inotropic response

37
Q

What happens to the heart rate variability in chronic heart failure?

A

It is reduced

38
Q

Why is the heart rate variability reduced in chronic heart failure?

A

Due to reduced sympathetic and vagal modulation at the sinus node

39
Q

What is the clinical relevance of reduced heart rate variability in chronic heart failure?

A

It can be used as a prognostic marker

40
Q

What hormones are involved in compensatory mechanisms in heart failure?

A
  • Renin
  • Angiotensin II
  • Aldosterone
  • ADH
  • Endothelin
41
Q

Why is renin released in heart failure?

A

Reduced blood flow to the kidneys results in a marked increase in renin production

42
Q

What is the result of increased renin in heart failure?

A

It leads to stimulation of the renin-angiotensin-aldosterone system

43
Q

What are the effects of angiotensin II?

A
  • Acts as a potent vasoconstrictor
  • Stimulates release of noradrenaline from sympathetic nerve terminals
  • Inhibits vagal tone
  • Promotes release of aldosterone
44
Q

Where does angiotensin II act as a potent vasoconstrictor?

A
  • Renal effect arterioles

- Systemic circulation

45
Q

What is the action of aldosterone?

A
  • Increases sodium and water reabsorption

- Increases excretion of potassium

46
Q

Where does aldosterone act to increase the excretion of potassium?

A

In the renal tubules

47
Q

What is the effect of aldosterone increasing sodium and water reabsorption?

A
  • Increases blood volume and central venous pressure (preload)
  • Increases peripheral oedema
48
Q

What is the effect of volume expansion caused by aldosterone in chronic heart failure?

A

Leads to pressure overload resulting in the release of natriuretic peptides

49
Q

What is the action of natriuretic peptides?

A

They antagonise the effect of angiotensin II on vascular tone and sodium reabsorption, causing vasodilation and natriuresis

50
Q

Where does anti-diuretic hormone act?

A

On the renal collecting ducts

51
Q

What is the action of ADH on the renal collecting ducts?

A

Increases water permeability and reduces urine formation

52
Q

What is the result of the increased water permeability of the collecting ducts due to ADH action?

A

It increases total blood volume and so preload and afterload

53
Q

What is endothelin secreted from?

A

Vascular endothelial cells

54
Q

What is the function of endothelin?

A

It is a potent vasoconstrictor

55
Q

Where does endothelin have pronounced vasoconstrictive effects?

A

On the renal vasculture

56
Q

What does the vasoconstrive effect of endothelin on the renal vasculture promote?

A

The retention of sodium

57
Q

What is the clinical relevance of plasma measurements of endothelin-1?

A

It is used as a prognostic indicator in heart failure

58
Q

How effective are compensatory mechanisms in heart failure?

A

Only offer limited improvement

59
Q

What is the limitation of compensatory mechanisms in chronic heart failure?

A

Increased cardiac filling initially increases cardiac output as per Starling’s law, but prolonged excessive filling results in progressive dilation of the heart, triggering hypertrophy and eventually failure

60
Q

What is the result of increased renin in heart failur?

A

TAS Cardiology (7 decks)

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