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Case 2 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

The closure of which valves cause the first heart sound, S1?

A

Mitral and tricuspid

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2
Q

The closure of which valves cause the second heart sound, S2?

A

Aortic and pulmonary

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3
Q

What is systole?

A

When the ventricles contract and push blood from ventricles into circulation

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4
Q

What is diastole?

A

When the ventricles relax and fill with blood

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5
Q

What is heart failure?

A

A syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump to support a physiological circulation

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6
Q

Describe the cardiac cycle

A

Right side:
vena cava –> RA –> tricuspid valve –> RV –> pulmonary valve –> pulmonary trunk –> pulmonary arteries –> lungs

Left side:
pulmonary veins –> LA –> mitral valve –> LV –> aortic valve –> aorta

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7
Q

What is stroke volume?

A

The volume ejected by a ventricle

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8
Q

What is preload?

A

The degree of stretch in the ventricles at the end of diastole

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9
Q

What is end-diastolic volume?

A

The blood in a ventricle at the end of diastole

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10
Q

What is end-diastolic pressure?

A

The pressure in the LV following the completion of diastolic filling

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11
Q

What is preload proportional to?

A

Stroke volume

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12
Q

What is afterload?

A

The pressure needed to be overcome in order to pump blood from the ventricle into the circulation

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13
Q

What can cause afterload to be higher?

A

Hypertension
Stenosis of the aortic valve

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14
Q

What can reduce afterload?

A

When the ventricular wall is thickened

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15
Q

What is systolic heart failure, what does it usually affect and what can it be caused by?

A

When the ventricle can’t pump blood effectively during systole
Usually affects LV
Increased afterload, damaged muscle, hypertrophy

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16
Q

What is diastolic heart failure?

A

When the heart chambers can’t fill with blood in diastole

17
Q

What is compliance?

A

How easy a chamber is to fill

18
Q

When can ventricular compliance be reduced?

A

Impaired ventricular relaxation
Hypertrophy

19
Q

What are some systemic causes of heart failure?

A

Anaemia
Sepsis
Hyperthyroidism
Liver failure
Excess fluid

20
Q

What is left ventricular failure and what can it then cause?

A

Persistently elevated ventricular pressure in LV
Pulmonary oedema and SOB (which is worse when lying down –> PND)

21
Q

What is right ventricular failure?

A

RV is not pumping as efficiently as it should be

22
Q

What is the most common cause of right-sided heart failure?

A

Left-sided heart failure
High pulmonary pressure from LV –> excessive afterload in RV –> works harder and fails

23
Q

Treatment of heart failure

A

Decreased cardiac output in heart failure is sensed by baroreceptors and kidneys –>
Stimulates RAAS –>
Increases pumping of heart and body retains fluid
This helps initially but ultimately increases afterload which causes more heart failure

Drugs try and remove these effects –> help the heart function or assist kidneys to remove excess fluid

Pacemaker or implantable defibrillator

24
Q

What is a heart murmur, what can they be caused by and what can they be in terms of timing?

A

Heard when blood flow through the heart is turbulent
Caused by stenosis (narrowing) or regurgitation (leaky valve)
Can be systolic or diastolic in timing

25
Q

What best describes the timing of a systolic murmur?

A

Between S1 and S2

26
Q

What best describes the timing of a diastolic murmur?

A

Between S2 and S1

27
Q

Describe how Starling’s forces can lead to oedema in heart failure

A

In heart failure, pressure backs up in the venous system which then backs up into the capillaries, so hydrostatic pressure is greater than oncotic pressure –> fluid forced out into tissues causing oedema

28
Q

Name the 2 types of drugs which can be used to treat heart failure, how they can help heart failure and give some examples of each drug

A

ACEi - lisinopril, ramipril, captopril, enalapril
Beta blockers - bisoprolol, carvedilol, nebivolol

These drugs block the compensatory response to heart failure which improves symptoms

29
Q

Which drug can also treat heart failure by increasing the force of contraction?

A

Digoxin
It has a positive inotrope effect which inhibits the Na+/K+ ATPase pump –> increased concentration of intracellular Ca –> more forceful contractions

30
Q

Which type of drugs can be used to relieve SOB?

A

Loop diuretics
Furosemide, bumetanide, torasemide
Reduces solute reabsorption in thick ascending limb of LoH
Promotes urinary excretion of solutes and water

Case 2 (8 decks)

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