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physiology IV > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Define heart failure:

A

inability of the heart to meet the metabolic needs of the body

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2
Q

Is heart failure the same as cardiac dysfunction?

A

No it is not

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3
Q

Why is clinical diagnosis of heart failure so difficult?

A

There is no one single finding that is definitive

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4
Q

What are the two main causes of heart failure?

A

Decreased circulatory supply and increased circulatory demand

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5
Q

Give some examples of decreased circulatory supply

A

Coronary Heart disease, Valvular heart disease, cardiomyothay

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6
Q

Give some examples of increased circulatory demand

A

hypertension, thyrotoxicosis, anemia, A-V fistula

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7
Q

Name the three adaptation mechanisms and when they are used:

A

Frank- starling (short term)

Neuro-hormonal (intermediate

Hypertrophy (long term)

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8
Q

In heart disease, when ventricular EDV is increased, does ventricularn performance also increase? (hint: frank- starling mechanism)

A

No, it does not

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9
Q

Why does pulmonary edema commonly occur with heart failure?

A

It is a common symptom because the LV filling pressure increases to at or above a critical point (25 mmHg) where the oncotic pressure of the plasma pressure is exceeded. This leads to fluid crossing the alveolar membrane.

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10
Q

What are the different mechanisms that result in increased sympathetic stimulation (increased plasma NE)?

A

1- increased release by neurohumoral endings
2- increased uptake by neurohumoral endings
3- decreased rate of NT degredation
4- beta 1 receptor exhaustion
5- decreased beta 1 receptor synthesis
6- increased coronary sinus NE output

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11
Q

What is plasma norepinephrine an estimate of?

A

It is an estimate of sympathetic stimulation

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12
Q

What is increasing levels of plasma norepinephrine associated with?

A

It is associated with decreasing length of survival in heart failure

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13
Q

In heart failure, blood flow is maintained to brain and heart during exercise at the expense of what?

A

The skin, skeletal muscles, gut and Kidneys

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14
Q

What is the stimuli for the renal (neurohumoral) adaptive mechanism?

A

decrease in glomular filtration rate—> decrease in renal blood flow —-> aldosterone

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15
Q

What is the response in the renal (neurohumoral) adaptive mechanism?

A

increase in Na and H2O reabsorption, increase plasma volume, increase venous return, increase venous pressure

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16
Q

Which beta receptor (1 or 2) is reduced by heart failure?

A

Beta 1 receptors

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17
Q

What are some of the effects of angiotensin II release?

A

myocardial hypertrophy, increased NE release, Na+ retention, vessel hypertrophy, increased aldosterone

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18
Q

Are the levels of ANP, endothelin, arginine vasopressin and PNE increased or decreased during heart failure?

A

They are ALL increased

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19
Q

Where does endothelin come from and what does it do?

A

It is from endothelial cells and it is a vasoconstrictor

20
Q

What does ANP promote?

A

vasodilation

21
Q

What other molecule has similar mechanism to ANP?

A

Brain natriuretic factor

22
Q

What is hypertrophy?

A

increased in myocardial mass (remodelling)

23
Q

What happens to the hypertrophy is the abnormality in the heart can be fixed?

A

it will regress

24
Q

When does hypertrophy occur?

A

During pressure and volume overload

25
Q

What is the definition of ejection fraction?

A

= (EDV-ESV)/ EDV

26
Q

Is the muscle increase effective in hypertrophy?

A

No, the muscle is not as effective, even though there is more of it, because there is a decrease in active tension which leads to a decreased contractability

27
Q

Does concentric or eccentric hypertrophy lead to elongated sacromeres?

A

eccentric (they are in series)

28
Q

What type of hypertrophy does volume overload lead to? What about pressure overload?

A

eccentric= volume overload

concentric= pressure overload

29
Q

Is left ventricle thickness greater with pressure or volume overload?

A

pressure

30
Q

Is left ventricle volume greater with pressure or volume overload?

A

volume

31
Q

What is the h/R ratio greatest in/

A

pressure overload vessels

32
Q

What is the disadvantage the the frank starling adaptation?

A

high left ventricle end diastolic pressure (leads to pulmonary edema)

33
Q

What are the disadvantages to neuro-humoral adaptation?

A

1- increased myocardial O2 consumption
2- arrhythmias
3- deminished response to sympathetic stimulation
4- blunted baroreceptor function
5- increased systemic vascular resistance

34
Q

What are the disadvantages to renal adaptation?

A

1- peripheral/ organ edema

2-decreased renal function

35
Q

What are the disadvantages of myocardial hypertrophy/ remodeling adaptation?

A

1- decreased contractability
2- necrosis and apoptosis
3- decreased coronary reserve
4- changes in matrix

36
Q

What is adaptive mechanism failure characterized by?

A

worsening LV function, fluid retention (pulmonary edema), excessive increase in vascular resistance, renal failure

37
Q

What characterized right heart failure?

A

pulmonary embolism, cor pulmonale, mitral stenosis

38
Q

What a characterizes left heart failure?

A

mitral insufficiency, aortic stenosis and insufficiency, hypertension, cardiomyopathy

39
Q

What is characteristic of acute CHF?

A

myocardial infarction and endocarditis

40
Q

What is characteristic of chronic CHF?

A

cardiomyopathy, hypertension

41
Q

What is characteristic of low cardiac output?

A

cardiomyopathy and coronary heart disease

42
Q

What is characteristic of high cardiac output?

A

Thyrotoxicosis, anemia, and AV fistula

43
Q

What is forward heart failure an effect of?

A

Low cardiac output

44
Q

What is characteristic of diastolic heart failure?

A

delayed relaxation and increased stiffness (rare)

45
Q

What is a good agent to treat diastolic heart failure?

A

Aldosterone antagonists

46
Q

What are some treatment options for CHF?

A 
1- treat underlying cause
2- ionotropic agents
3- diuretics
4- venodilator
5- arterial vasodilation
6- beta blockers
7-aldosterone antagonists
8- LVAD
9- transplant
10- internal defibrillator

physiology IV (40 decks)

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