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Patho > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

heart failure (HF)

A

inability of heart to pump sufficiently

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2
Q

HF may result from what?

A

loss of ability to contract
impairment to outflow
excess work demands

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3
Q

what does HF result to?

A

↓output (forward effect)
congestion (backup effect)

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4
Q

what does ↑workload of ventricles result to?

A

hypertrophy and eventually failure

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5
Q

which ventricles does HF involve?

A

initially involve left or right ventricle

once one ventricle fails, other will eventually fail as well

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6
Q

HF can result from two kinds of dysfunction or both

A

systolic & diastolic dysfunction

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7
Q

systolic dysfunction

A

heart fails to generate enough force to adequately pump blood => ↓contractiliy and stroke volume

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8
Q

diastolic dysfunction

A

reduced ability of ventricle to fill d/t failure of myocardium to relax or ↑stiffness of ventricle or valvular stenosis

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9
Q

what effect does systolic dysfunction lead to

A

“foward” manifestations of HF - ie. ↓CO

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10
Q

what effect does diastolic dysfunction lead to

A

“backup” effects of HF - ie. congestion

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11
Q

HF etiology, all of which lead to ↓CO

A
  • MI
  • tricuspid, aortic valve incompetence
  • pulmonary, mitral, aortic valve stenosis
  • respiratory disease
  • pericardial disease
  • hypertension
  • hyperthyroidism
  • myocarditis
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12
Q

result of respiratory disease in HF

A

↑pulmonary resistance - damage of lung capillaries => ↑workload for right ventricle

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13
Q

result of MI in HF

A

↓muscle/contractile mass

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14
Q

result of tricuspid valve incompetence in HF

A

↓left ventricle preload

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15
Q

result of pulmonary valve stenosis in HF

A

↓left ventricle preload
↑right ventricle afterload

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16
Q

result of mitral valve stenosis in HF

A

↓left ventricle preload
↑right ventricle afterload

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17
Q

result of aortic valve stenosis in HF

A

↑left ventricle afterload

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18
Q

result of aortic valve incompetence in HF

A

volume overload

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19
Q

result of hypertension in HF

A

↑afterload
↑left ventricle workload

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20
Q

result of hyperthyroidism in HF

A

↑metabolic rate
↑SNS => ↑BP, tachycardia, HF

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21
Q

result of pericardial disease in HF

A

restricts filling of heart

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22
Q

result of myocarditis in HF

A

bacterial or viral infection => loss of contractility

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23
Q

congestive heart failure (CHF)

A

HF accompanied by congestion of body tissues w/ blood

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24
Q

impaired heart function symptoms

A

initially asymptomatic - period of compensatory mechanisms (compensated HF)

eventually measures fail and/or aggravate failure => decompensated failure w/ symptoms

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25
Q

CHF compensations

A
  • frank-starling mechanism
  • ↑SNS
  • renin-angiotensin mechanism
  • ↑endothelin
  • myocardial hypertrophy
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26
Q

frank-starling mechanism compensation of CHF

A

↑preload (ventricular end-diastolic volume) => ↑stretch, contraction force

however,
over-stretching => ↓contraction force, ischemia - ↑O2 demand => impaired function

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27
Q

↑SNS compensation of CHF

A

baroreceptor reflex => ↑HR, ↑total peripheral resistance, ↑contractility

however,
↑HR => ↓ventricular filling, arrhythmias and ↑total peripheral resistance => ↑afterload

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28
Q

renin-angiotensin mechanism compensation of CHF

A

activated by ↓blood flow to kidneys

however,
↑total peripheral resistance => ↑afterload and angiotensin contributes to hypertrophy

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29
Q

↑endothelin compensation of CHF

A

released from blood vessel endothelial cells

strong vasoconstrictor

however,
↑total peripheral resistance => ↑afterload and endothelin contributes to hypertrophy

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30
Q

myocardial hypertrophy compensation of CHF

A

response to ↑workload
↑number of contractile elements

however,
↑O2 demand => ischemia, fibrosis, impaired function

remodeling of ventricle => ↓chamber size

31
Q

left-sided CHF etiology

A
  • volume overload
  • pressure overload
  • loss of muscle mass
  • loss of contractility
  • restricted filling
32
Q

volume overload in left-sided CHF occurs

A

occurs w/ regurgitant mitral or aortic valves and high output states such as anemia or hyperthyroidism

33
Q

pressure overload in left-sided CHF occurs

A

occurs w/ hypertension and aortic stenosis

34
Q

loss of muscle mass in left-sided CHF examples

A

examples:
left ventricular MI
inflammatory disease like lupus

35
Q

loss of contractility in left-sided CHF occurs

A

can occur as a result of bacterial or viral infection (ie. myocarditis) or from certain poisons and toxins

36
Q

examples of restricted filling in left-sided CHF

A

example:
mitral stenosis
pericardial disease

37
Q

left-sided CHF manifestations

A
  • forward effect: ↓CO
  • backup effect: pulmonary congestion
38
Q

how is forward effect manifested in left-sided CHF

A

fatigue, weakness, dyspnea, exercise & cold intolerance, cyanosis

39
Q

compensatory manifestations of forward effect in left-sided CHF

A

tachycardia, pallor, daytime oliguria, nocturia, polycythemia

40
Q

uncompensated manifestations of forward effect in left-sided CHF

A

cyanosis, anorexia, cachexia

41
Q

what does backup effect lead to in left-sided CHF

A

↑capillary pressure and edema - fluid forced into alveoli

interferes w/ gas exchange => hypoxemia and predisposes to pneumonia

42
Q

how is backup effect manifested in left-sided CHF

A

orthopnea, cough, dyspnea, hemorrhage in lungs (blood in sputum)

43
Q

right-sided CHF

A

often follows left-sided CHF as pulmonary congestion impairs flow into lungs from right ventricle

44
Q

right-sided CHF causes

A
  • left ventricular failure
  • loss of muscle mass
  • cor pulmonale
  • tricuspid valve incompetence
  • pulmonary valve stenosis
  • congenital defects
45
Q

left ventricular failure in right-sided CHF

A

pulmonary edema increases afterload on right ventricle
ie. hypoxic vasoconstriction

46
Q

loss of muscle mass in right-sided CHF

A

right ventricular or inferior MI

47
Q

cor pulmonale in right-sided CHF

A

right ventricle failure occuring secondary to pulmonary disease

48
Q

impaired ventilation in cor pulmonale

A

=> pulmonary vasoconstriction that increased afterload and often results in failure

49
Q

what can cause cor pulmonale

A

pulmonary embolism

50
Q

congenital defects in right-sided CHF

A

pulmonary obtructions or shunts can increased workload on right ventricle causing it eventually fail

51
Q

right-sided CHF manifestations

A
  • forward effect: ↓CO
  • backup effect: congestion in systemic circulation => peripheral edema
52
Q

forward effect in right-sided CHF

A

same as left-sided CHF

53
Q

manifestation in backup effect in right-sided CHF

A
  • generalized edema, ascites or dependant edema
  • hepatomegaly and splenomegaly
  • ↑jugular venous pressure
54
Q

ascites

A

collection of fluid in peritoneal space

55
Q

dependent edema

A

swelling of feet and legs

56
Q

hepatomegaly and splenomegaly in right-sided CHF

A

fluid accumulation in liver or spleen => distention and upper quadrant pain

57
Q

↑jugular venous pressure in right-sided CHF

A

congestion into cranium can create CNS symptoms: headache, visual disturbance and flushed face

58
Q

most common cause of CHF in children

A

congenital heart defects

59
Q

s/s of CHF in children

A

same as adults:
- tachycardia
- fatigue
- effort intolerance
- irritability
- cough
- anorexia
- abdominal pain
- oliguria
- hepatomegaly

60
Q

differences of CHF in children and adult

A
  • dependent edema and ascites are rare
  • jugular distention is hard to detect
  • excessive sweating
61
Q

why is jugular distenstion hard to detect in children w/ CHF

A

children have short, chubby necks

62
Q

most common difference of CHF in children

A

interstitial edema in lungs is more common than alveolar pulmonary edema -> impairs ability of lungs to expand (ie. ↓compliance) and ↑work of breathing

63
Q

what does interstitial edema lead to in CHF in children

A

tachypnea
↑respiratory effort

64
Q

two kinds of drug therapies for HF

A

drugs that reduce mortality
drugs that reduce symptoms

65
Q

how do drugs that reduce mortality work for treating HF?

A

↓workload of heart

66
Q

drugs that reduce mortality

A
  • ACE inhibitors
  • beta blockers
  • aldosterone antagonists
  • coronary vasodilators
67
Q

ACE inhibitors in HF treatment

A

ex: Altase, Coversil

↓angiotensin activation blocks systemic vasoconstriction effect

68
Q

beta blockers in HF treatment

A

block beta adrenergic receptors => ↓epinephrine effect

beta-1 blockers can ↓renin release and ↓cardiac muscle contraction

69
Q

aldosterone antagonists in HF treatment

A

block effects of aldosterone => ↓absoprtion of Na+ and water => ↓BV => ↓BP

70
Q

coronary vasodilators in HF treatment

A

ex. nitroglycerine

cause coronary arteries to dilate and ↑blood flow to myocardium

71
Q

drugs that reduce symptoms

A
  • digitalis
  • vasodilators
  • diuretics
72
Q

digitalis in HF treatment

A

alkaloid derived from foxglove

↑vagal tone => ↑contractility => ↓HR => ↓workload

73
Q

vasodilators in HF treatment

A

ex. ACE inhibitors, nitrates, CCBs, alpha-1 blockers

cause ↓systemic vasodilation => ↓afterload

74
Q

diuretics in HF treatment

A

ex. lasix

↑urine output => prevent fluid overload

BV does not increase => ↓risk of edema, dyspnea

Patho (11 decks)

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